Scribd Logo
Importer

Bienvenue sur Scribd !

  • 13

    Transféré par

    Carlos Hernández
    90 vues215 pages
    fwefgrfefg

    Copyright

    © © All Rights Reserved

    Formats disponibles

    TXT, PDF, TXT ou lisez en ligne sur Scribd

    Avez-vous trouvé ce document utile ?

    Ce contenu est-il inapproprié ?

    Signaler ce document
    fwefgrfefg

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme TXT, PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    90 vues215 pages

    13

    Transféré par

    Carlos Hernández
    fwefgrfefg

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme TXT, PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 215

    var title_f6_13_6352="Calcified pleural plaques PA";

    var content_f6_13_6352=[" <div id=\"graphicsToolbar\">",


    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=PULM
    %2F55085&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=PULM
    %2F55085&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\" style=\"width: 470px\">",
    " <div class=\"ttl\">",
    " Calcified pleural plaques",
    " </div>",
    " <div class=\"cntnt\" style=\"width: 295px; height: 324px; background-image:
    url(data:image/jpeg;base64,/9j/4AAQSkZJRgABAQAAAQABAAD/2wBDAAYEBQYFBAYGBQYHBwYIChAK
    CgkJChQODwwQFxQYGBcUFhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChM
    oGhYaKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wAARCAFEAS
    cDASIAAhEBAxEB/8QAHwAAAQUBAQEBAQEAAAAAAAAAAAECAwQFBgcICQoL/8QAtRAAAgEDAwIEAwUFBAQAA
    AF9AQIDAAQRBRIhMUEGE1FhByJxFDKBkaEII0KxwRVS0fAkM2JyggkKFhcYGRolJicoKSo0NTY3ODk6Q0RF
    RkdISUpTVFVWV1hZWmNkZWZnaGlqc3R1dnd4eXqDhIWGh4iJipKTlJWWl5iZmqKjpKWmp6ipqrKztLW2t7i
    5usLDxMXGx8jJytLT1NXW19jZ2uHi4+Tl5ufo6erx8vP09fb3+Pn6/8QAHwEAAwEBAQEBAQEBAQAAAAAAAA
    ECAwQFBgcICQoL/8QAtREAAgECBAQDBAcFBAQAAQJ3AAECAxEEBSExBhJBUQdhcRMiMoEIFEKRobHBCSMzU
    vAVYnLRChYkNOEl8RcYGRomJygpKjU2Nzg5OkNERUZHSElKU1RVVldYWVpjZGVmZ2hpanN0dXZ3eHl6goOE
    hYaHiImKkpOUlZaXmJmaoqOkpaanqKmqsrO0tba3uLm6wsPExcbHyMnK0tPU1dbX2Nna4uPk5ebn6Onq8vP
    09fb3+Pn6/9oADAMBAAIRAxEAPwD5rjSNumT7dxUv2UYyj9O1RLEc8ZyfSrMRdPvJuX3oAaPSVA49xz+dPW
    zgm4QtE3oeRVqCSOQhT8h9G5H51pwacJlBj6npjmgDnp9MuIU3uhaP+8hyKpPGy4PBX19a7y2tprYDbk47c
    EflVqTRdO1FCWBtJzySq/KfqKAPNt1LnvXSaz4S1CxzJ5Rmtz0miG5fxx0rD+yun3wfrQBWxnFLs/yasrCS
    cAc+1WUtBuUEZJoApQws5woOfYVsWViy7WcqvTC4yfxq7YWDniJM84J6AfjW1ZWEMZzNKC391OTn69KANTT
    dPiWFSsbyMOctyPyrUS5kt4ypRoxgjIGKks7uyt4fnJAHA8sDd/Oqeo6rGWxFAyg9mG7P4UAdloGpC4tGV4
    xIVXsSDj1A/wA8Vt2d7FEVLrLn+8pyo9sda4bwvK88oMHk+YvJQgjHsBmuwtpY3mYSqbWVf+BKT7UAeheGW
    t7qLO9lJOQT+ufxzUnj2SRlt447diNv3kbLE9KxNInmtpUHyPu+9sYNkeoq1r013c2kU8UmY0YxEBR1+tAH
    nsWjXt3fiTW5PstnG4xbIR5kmP5fWu2i8R2+oNe21whto5CJI3hOCu0nHXqB6VyOrRy21zIsjsXj7Fgx+me
    ap6QGmBVIy8m/bvzn3x/9agD6A0Zn/s9ZnvS4MeVDjJ/Cpb24jit2xM80rHGcdCfr0qlpvltBbRSHGyNcnp
    zjjP4/lVm9tJHhLZVedzMDmgDldcjXyTIcKVBwoHJ+vrXFyaymlxNOFjhl67pOSPXHvXoGtDyNPeWZc4U7U
    PXn+I/4V80+Nddku9QnCuQqjA9FHrj1NAG7rXxCa2mcWrRl8kn90Cw/wrmL3x9fXZJl7/xMc/pXDTXEgJ5P
    zHk561SklYnrwaAOuuNauZWWRWhDdclOh9qrxavdRIIg8bxgYAdA2PzrmoZmU8k7T+lWIleRsICzE9qAN0X
    dvKR9ot0A/vKP6VOuiwXrj7JBHMx6AICTUOkaPd3kgREkYk/djUsf04FeoeDtIh0CaOa/fY4PEK/Mx6fePa
    gDB8JfCSfWLopdWSR8ZXEY2/Q/4V203wb0nSQHnsoruQqNqrCNoPvXqei+ILPUlSIBLIrjaU74/n+n410Gr
    RJbWBuricJaf3pBnr2A65+tAHzXrPw3heJpLXSLONRxgQKBn+dcbf8AgaK2BN1ZpAoHBZdoP09a9m8Va7Jp
    8jPocBCtlRdTkl8/QcA8fj+leZ67qkmsZGvTSTPnCy8Ar/wHp+WKAOn8AeH/AIZeLPCQ8ManDaaX4kTIF8M
    I8w3ZDIzcE44INW5/2bNAR0a21nUWjDZYzKgVgD0BGOvTNeMarpqxyEApNGT8rdQfTr3qWyfVb0pZR6jqLr
    J8vktdy7Me67sYAoA6L44eGvBGhz2Gn+ErdE1FGZr3y7qSYIuMBSSxAJPOB6UUf8INbRRqhuZFdRlgECrn2
    ooAp2vgfcqtcXgTjLKkZJH4nim6z4RFtYm4s/MlRMeZu6geuPSvYJ7KO6iSeW3CgrsZoxgo3vjoKZHozM/l
    x7pYhG3nAjGUAzxigD52mtdhxjvU9hPcW8m63dgfT1ro9e0R7LUZ4ZFxGp4J9O3FU4Lbyl88wb4weHk+6fw
    70AdL4ad9VIF/p6Rwrw17EwVUHq2eB+dd5Z+GPDBQPFqg1JgMlU+VQfQEcNXjtxqE11OgndnjU/KmcIv0Ha
    tzQ5pobhHt3MZPO0Dj8qAPW7NIbRvJ07yEjYBDGYyVYfjTNW8C+HdYRla3GnXbAMJIBuQnpkjoB6U/wrqMM
    lm02rERA5Csq5DevHaukt7eK6VrmWVIbfGcDkjjt+lAHjGs/CPULaTFgFnjznzYz+rA9P5CuZk8LXumK0st
    t52f+WmPkA+nU/yr6TS5uQUitUaK1z9zPLf7TetaElpp1xGWvolhdhgMnU/Ud6APly2sHuSGllLJnAVBtH0
    q1Ksdu32a2iXfj5nPUewr3/UfCunyo7WdpBdOR6iNh+WK8r1DRbiyE7NZPCVYsQ6nn2z6UAUNKhAskHkRgA
    ckDlqW+DF9sWSOmQBiqi6tdROwe2Gz7uMVYh1KS5kK/ZCMdMdPyNADtKjKXI8sgvnJB9a7qEIEX7Rk7hkEr
    8y+3uK5DT7cygyo2CD0Y4Ndfo7s0OLksRH0zzx6UAPtndSjxuAFfgryB9P/AK9dkLppNCugG3MoVsHALHOO
    tcu9uiGQwNlGPy54J96q6i81vpl8qqobYAGH8JJHX8qAOX8SjUryJxGnllCfMYuCQPTjtWj4HtIbTT4rPUL
    jfPevLIJVyoj2gbevXv09a5G/N2ls0sSudjENjOc465qto2up5kLStIr27MqA8kg4HH40AfS9hb3Jitpjcx
    FDGoPO3t05rq7VUVAJ3V8DnAOPx9TXC+H7ptQsrWQnZlF4zx0wf5V2LL9lSRvmYIOGPIIxzQBwvxh1aOw0Q
    wWkn76cY4HKL3P1r5V1KQCVnkJwDkD+8f8ACvdfiNdnUb24jhjL7cruGSP8MV4TqsIjkYuSX7L6e9AGHMwJ
    LOcAmqzzbxgDirQtpJ3+VWYD8BUsdhDGA0zbj12A4oAowRmZtuGZuwFdRp+mRpEjXkoiXsifeqlaALKixRq
    q54rbZAyb2wjg9hgGgDT0m/FmDHpym26AsDlm962/7XkChpXWYKPmaYZ+pz2rkZtRt7WHlUllHRccfUmsS9
    1KW54kbCddq8L+VAHpY+IcFkWWwiYTnjzjl419wOv6V2Hw7+Isl1ey2uuXTXtlcYBkyGMRPAOOw+tfOLTZ5
    Dd+lPtL2a3ulkhkZHB4ZTgrQB9VeI9HjMjxRuuWByh+649R6HvXj+r2DRzyxTpgocHNd98L/F8Hiiwg0vWJ
    Vg1NVEcNwfuSkdA3ocYGe9aXirw1NcRNvixfxnaB/f8AYn+X5UAeOpYOUkaNN5QZKkdV7/lXXfDzw/Z6gz3
    FtIrXuQiwv1A4JIPfPT/9dUotOltbpZWDJhhzjp711+laVply8F5Z381jfo4dlSPdGzdyCPun9KAKs+l3v2
    2SBbK5e6DHMaIS2PYelFev6Z4kEdoltq9vcRRjg3PmiTfjplf8KKADw54TEUENzJLtjkGGhnIXPqCOjVV1n
    xDpWh3j21pZxWx2lWkkQAfUckkfTg15ZrvivULlg89w2APlVW4UelYE3iqdYWidFuIyMbZPmB/qKANjxHY+
    F7m6mvkvry8un52SxBIQe+MHJ/TFec+IZGknYbwVXhcYAA9ABWjc6xYy7ibGSNucssxwP+A9qrrDb6gyrbO
    wl6bJcAMfY9KAMCwtZJZvkxk9q7rQ9HkWSPzFAZsYUnB+p9B71T0+3nhnWCNhEzEjGOnrz6cGut0dQIpZBK
    FUcNO/QKOpOfXoBQBfjP7tLW2G7A+
    +Rg4HU+wpi38scwa3kJijOFiQ5Gem49sn+WKo3F697FLFZ7o4XITP8Tj3rodMsI7bTlSZNr4JA9/egDR0fW
    prpzHc7YBgA45z/Wt+aNGVWjbcDzxyB9a4u3Cw+Y8rKMjILHr9KswalGju4ldpcADZwtAHW20nlEELh84zj
    pTNXu5Ws5opAsgb5gHG4H2rFg12VeJIY27Dnmp76+a4g/dSeW+MnK8ZoA4TVV01bvbcwm2Lnlo+g/CqEvhv
    dIxs7iF0P3Q5KfTmqXi9rpLsOZC8XXOQR/8AXqromq3Fu/lNIJInOAGH3T25oA2NB0+5tZpIbqB9jdOdw4P
    sa6O2s5II90SSMpOGB7f/AFq5+w1VIrjzX3hUb5ivU9sV2drdLcQrJC+/PTHP4GgCG2tZriQryhHX0xWlqN
    vCdIuguVfapLnJBxjr+VRTMPLBjchwwxtPSs+
    +kuXtLpCxzIuN30INAHDeIftQ8+EqVLjJJOFHFecQXF/bXLRtLt2NjhQcEdwcV63MLlPLlEpYBtrL7475pG
    sra7iuLh4f3jAAHaMZ+npQB33wvnuZfD8MkkgIAxk/hXb6jLJcWEghZ2hGQcfdAx39q53w1K1r4bt4okAyv
    BA61p3VxP8AZ3VeGPBXPHTvQBxt1FZyxuyyXB+U7vkHzNyOT/8AWrx7xVHZWkxjt4MyfxSStub9MCvXtUiN
    vYykk4x97sK8M8WFvtjszBh7UAYdw7zMfLbAPJ/wqBYwhGXFSOWFqXAAjz949c1nNcbmzGDjoT3oA6jRre1
    XfPczKiAcDGTmqV/quYmjjjwM/eJ61ii5cRbASB6dqrySM2ckAe560AWTedcoDn3qu867SGRvTg1Bjtn6VH
    Jk9xQA9mUkYbHs1JHvWRSfu+vaoSDnk55oR2R8qSMc0Aem+HtOeCKCZLqIY+cNu7n/ACK+ivCmoLr3heFr5
    iJYl2h+rMQOR6n1r5UtNfjm01bUDyJwc7gflb/A16V4C8cvZ3Fppl6GW3CqN3Qhs5DfXOKAO+8W3UEEDXdr
    p8cpLbJzOWbDeuAQMH+dcLF4ivArZVIlU4CwjYAPoK9M1XT43eRchoLqLO7OeDyD9Qa8o1i2NtcMuDwcH60
    AaNvrCSHJDq5PJPU/rRXNszhjtbGODz1ooAuXjlkwAMEflXN3bbXIHJPaty4UtGMYJJ+93xWTcxeXuZ85Pf
    2oAzHJbIPT+VXtPQo3yjhqqyAzMAowa2tFtg9wnn/cX52/3RQB1pV2sbMDaby7TazEfdUE8n3IA/IU3Up0M
    EVrCNtrD0Hd2/vH+gqzdObfRY7uTCy3LNHH3IXPP9BUOmS2SI8uoKzBx+4VT8zEfyHvQB0vgrTEa2m1C62+
    TF/E/Az/AFpNb16JS0diuT1Mjcn8B2rJt9Tup4zGrbYQflUDCgew/wD11XmsRCQ2WcnqB2oAgkuJZZsyOzl
    uMseTWlas+1cIGz0PQVVMDRfNsABGfrWhagIoLfNtGR7e1AFuOCWGIyy7RtHrzj/Oaq/2pIwO2QIw+UcdRU
    80sxtXjjIG4cHPNZYs3EYfeQB1GMj8KAMbxDDJcEG1lZZsbsEAK/4Vj215bysscyyW82cFWOFJ/oak8Qalb
    GeGNJVDqdzjmiO9gmPzGN8jo4GR9CeaANO5t0mtjNGSJAf3inufX8v5Vo+Fr42piinVgXPDZ7VQ06+WJGi2
    vtK4y3PHpmn3LATKq8AKOR2oA72fMyblPAIxgVYt7c/dyrqVIIJ5PFczoV5PIkkEgLRr91845/rW9ZurunO
    0gZKjOKAKGq2Uju8caFE6/KRkn3qxpWnlkiVyojYuzE8nNGoqzFgmGL8g5HJqtaQzojRBiEB4AbA//VQB3U
    DxrbW6RhQsa5AA6Yq6tyr21xIVj8wjK9vrWNFG0dpb/Kd3TgYOabeyeTayTGVUA4Kjknt+H1oAz9Win1Cwv
    RHh0O3nOCOT2FeMeO/CM+kubiaQMNu4Dpx9PSvVDfmCQlm+Q5+XPY9cV518S9c/tIgKg2oNow2QPTj86APM
    Z1lmlXzGBHRcHgfQVDIhDlTkBeNppszAPliBnn6Ugm8wnyz8w7kcmgBk6lDgryOOKgVSQxqW6L5GWIBFUt2
    XxkkfWgC0EaR9iDBPap5bQwj5iGc1Wg+8B6mrEshL7RwvfJoAgjg3Aggjmi4tWiweGQnGauxTtGpAI2nnmp
    5pIpdPkDbldWyDjg0AYaDJO3mum0a5Et5bwSuBJlVjkPb2PtXMspVs8Fe2Ohre8LWR1LVII2cKB1xyfb86A
    PqrwyX1PwtaR3J8u4jQAkjkHt+YriPFliRcTblZTn5gTkg9P6V3nhK1FnZ/2ZI5luLWFWV2U5ZOgyPWqfjO
    0SdornbklfLk7c9j+OP0oA8h+zN91s8c5orYcRLMyvjcCe2fzooAzXQbMsuOPyrF1A8spXofl4romTamCOv
    Qe1cxqDt9okHy7cjHXOfegCpGu9skbf8AGup0G3E9uzsAFJG7HoO351zsTFUZiR93IrsLGB0hsrcDEhVC+e
    zHrQBc1+QhbRrgfu4o9oQcBnY5C/ljPtVLSNKvr7VCsivJIx/hXHy9eB2Aq3rive6lbNGR+5fZECOh7mt+6
    Hk2o38BFxJJ2yev1oAzE+SRgg2qeiAcAe1Xo0RZF88/N12jk1RiuN7YQFF9T97/APV7VNbyAxsAMOW5I9KA
    LNzM8kzHZGqZztPUCoZArq4SY5xwpHA/GlQnzMtuJb9KkdN20qy4HboKAKFsyxz/AL1dxGRyTzW9ZXNsbfY
    wxLjHPesK4gK5YEA9x2NNtpCkhO7AAx0oAwfGHhbzrt9QsmKtnPlHj8BXOWltMrlJIGyp5Ur2r1KOdJ7Vgx
    Kv29z7isDVbT5CYm3JtwT3X/61AGLbQvarM4J2EBSp6jvnmtMTRyyIkij7g+celV5sjS1RsNKnQ9sVf06FJ
    2XJAcDIyOvFAHR2/lxW8ccJxtHJ9T61ZsTifcPmzxgCsIyOmcHGMfjWlo0+JH2g8Lke3NACTXCxSgyA5IyR
    +NXbS4HlFlJI3enQVj3jeZM7PndnrjrWhaBhb4UZyA+cdKAOrgkL2ik/ORnvzWXqUUk22NFY5XIAHWtPSUH
    lR7z947iSKtXJiBULGuAec0Ac4/hu4uIo9zCNj03jgcV5v8RvC91pdrvTbIp/5bdBnB4r3q0vSLiLKq8X8a
    4zn/Crvj2zstU8JXJjjTcIyFgP8eB0Ge/NAHwlOw81gGJI96hE5jYbeT61Lq1rJY6jcW8oKlHI569aqADOM
    80AWhcyPuDEEn2piI3mDjJ60QLmQfWuvMdhb6XDMgL3EmdwK5xigDnoYJFg81lIBOM46Ujo2M7Wraidlj82
    YkDGMFeKzLqR5JGOdq+lAEMYjYEuxBBxwKLmRYw8RYkHpjofSnIMqACoBH3vWkWHz228bs4BPPNAGarsjAg
    5z1B9K9L+GNraljfsiubZ1kKE8qc9fce9cn/Y6xqGlILkcqO3vRoeqXGkX4mtmKsMjBPBU9QfUGgD6N8HeI
    xfeNI4WPzSL5Gc53cdP8K6jVF84TWz5ZmjbHsw9/wP514R4a1B01my1W1ZwonUkFsmNu4z6V9DazEr6l9oj
    b9zN8y+gJ5P9aAPHb5MXLD7owDxRVzxBamK+YdMEjjpRQBSvU2KABgGuS1GLF0w6DNdvfKXjUj0PsDXMXcH
    m3CEc5ODnrQBBa2gkmiUjIB3t7gc4rtNEUeTJeOTmFCoJ6ljWLZ25V22DLbduT0HfP6VsqwisBAowshHB65
    9KAHabHG18JZceQOSfTt+ZrWuLqNoSJlBQ/KsZ7VzEs+
    +YRIMRqy5I7nNa+os7T4GBkZA9sUAK4twyxxo4BGRjkVDNbOMhF2qRnIbrSRRsjjLZJGcd6nhk3NtJ+buR3
    oAgjkyoRwSSOT2pzMfKyxIQHnB5qxcTDZsjwD1PvWfK52EYJHoe1AE+8bCrZdT+H+e1OtzEshO3IxyM1RLg
    cORwcc81MwCg7G3dOPagDTh+zyK2AeeN1U72OWNlwGXd/Fj9aihnA+XbjHvV5blXsZBIpwDnHWgDEmgk3HA
    DHBIH96rumxq2xsBSvtj8KktpF3RnaxXPFXbcJ5rIAAFyeeM0AOmhScSKqjGARxUVjG0cxHIxx7mnozhyQo
    GB2qa3DtIjkcnn2oAzr0EyvgY6cHpV2xkyEx99lAz9KivQEu3PlhgTU1qyKFbywNoyPrQB1FrIQwTPQDjOK
    tOgkkzkbmrO02RfJBVB1xWmrPJgAn8DigDRslWNucMR3POKxtc1GeW4jUL+6Vvlxzg/wB6r11NtQIGKs1Uh
    HGZYTJIXy4Pyc555+nFAHzf8X9Cm07xLI0saoZT5nyHI5rhY7ZnJyQijua9k/aC1iC6v3W3hSL5wwIGT0we
    a8bjdp2y7bsGgC7ZRQrcKGy+OgXnJ+tdVLHZ/Z0llYZ2nESH096x7G2jTTpJGZssQoIwQKhXUjEZlMYcFAo
    LDgUASXEzOwwGCDkKTwBWfPOCgVRjnnmoZLlyjc8E84qszlgeoFAFxJ0CFdpOeR7GrKogVSknJ6jODWXG2z
    lgDnoMU8MXcEtg9BigDYYBLaUszZRcAHuTWWhzIFbgZ9KtC+dbeSOXDKAMbj8w57Gq6IJVV4zlR+Y+tAHZ+
    AZMatDbE7opnCk9ge1fUNkVurFE+Xeo2jjoR/nFfKvgMPNrUCEjAOc+nvX1RpBeKDL7QxAcYHtzj8R+tAHE
    +IId10zHGd2Dx0ora8TWo86fbwNwZSPQ/wCTRQBysq7I3BHWuZEJW4Jx0JJrqLwnyi3IwMH/AD/WseNMwu5
    GVJ/OgCSw+S1mm9W2jNF5IYrFJFPzbiF/lkU+RStusAH3OCOepqO4jWWUxuT5MQCnuc98UAUrWKSZH2t8wH
    JOOfWty1ZpbVHznA2sfT0qpb2BDqsLlt6/d74qd3WzhlAILEDcgOFFADniZmEuTheeuMD3pslwmQ3U5BG2q
    treM1wFlbKt8vsKTy9k5GcN0xjj60ASyXTM5YqA2c/hUcwEoGc5GeO1RHJkJOcjrn0p+QQMHGR6UARGL+Jm
    4BHFPDbidjYY9M0yXAOB09ev+TQSfl4980ASgNJGCFZjn8R71Zg3KSG5+Xk9hUCuRjaCB1IqSJC7Fi2FHb1
    PoaAEBBUAk4z1NTQXH775jt46k1W2SOsj7MAnAI6VHEASzF+gI5Hf1oA2opVLS/NxsO3PY0tlMCqkc44Oaz
    ocNC0itkpx0wamsZlCZIHQjH5dqAGXM7G4bJwM9TU8MpEOeSB0IPWqF+
    +6ZnA4BqSzJ2Kq9C1AHU6PeD/VtkdCvHQ+9bi3KiRVJHPI4rjoZCrg5IOcY71q2lwQxQuOOR6kUAat7crNO
    UUPs6N6VqumnWVh9paTzJNh2r1wT7VylxO3m4Dk7iMLkVsNGiacIpEZztJyOgNAHz18XJJNR1iQxxqmwche
    Frzi1Vt4VRya9T8SaVcS3U7SKkm4kghuOvfFeb3NvLZXrB1IAOQCKALtzceXYRwH72SflPWqEABLmXcR2Hv
    UbEyTqSa2Yo7cANOwDNwDnFAGM2SSuO9KIWClnBCg1r3ltFCQ6FX/AN3tVCSVXjbcxB+nBoApPkkcUgkVCc
    AnA78U+eXByF7VXfLLknHqQaAIpJN2MnP9a0tPj80q
    IZdjY49z6VlupL4H512ngTRHvb6ESRbwRwB9e9AHc+ANBkmj+0rHsuFO2WMn7vofoetfQOhk3HhqCWYL5sB
    MZOMNt9PrXEySafoF9Y3eEhUxeVJGQQcdiSef512HhW6M2k3h4AMxOPYigCnreJIYhjg5Xn2oq1qkIWCNT0
    Vsg47YooA4G4YpbkEDpnJqCzgEkUeSc53YI/GqUN0Z9MgYkE/dOa0LYCMg4OQpyPwoAh+Y3zYxuALfQio44
    txSJQWbPXPX3qyq+XaXE4PyuQi/mM0WvEZbP7yT5QPQd6AGW7/YpJQD26+mew/KsuYCZWKtgjqlbV0rtEyY
    VV64IrM8kAtjqTnOaAKQDKy/Lz6irUDs7gOw3DjNDAErzgdOaVIXVSQDjP0oAcYefnJ6546Uu0bcHnvSBgq
    EHH59KaZlxlT29aAFZBxkH/d7inMVQLjBPXFMMqgjcAfTHamyTL/CpwPWgB7SqEBxjA9aW3mXzdxxz68VXk
    O5RntTIWQN0x9eaANQYfcSCRjOB61XjRVdww+XuR2ojlBdVBJ9+tFyrSD91jPcGgBt+rpHHDAW3FsttGcDt
    mltUf5tzLxxgdj35qhNJIb1poThR8pU9x2NaUNy+2PeBnPWgBJI0PBJyferumwhIxkk4OfUdap+fwSemeOa
    uWj7lGSOgGBQBoSxfvGkBJDHgYqrG7LdjaOh5960U2OiZG8jPWqFwcyNj5cHpQBt2iA3ULthlPTitfVNhs5
    g2FAyqZOOf8mub0+5VWMZPfjHY1f166X7KmOvUjHpQBzEtgiWzpsEch/iI4H+Nch4j8N/bNNdzbA3AX76Ka
    9O0udLiOJWhUyD+Lrj/GqNzanUrW6hjUIDJ26Ed8UAfM95p09hd+XcsIyvTd1NOkghd/8Aj5DFscEdBXSfE
    bSyt881tGRHF8mcdR71xW8qcnntQBrX08LCNIg3y989cVSZi/8ADUcYJUkjAHP1qOSbKfKuMUAPkVdnUZpF
    XABOD7GoV6bu47U0qxbd+fegDRt7Bp5FKD5G9K9c8D6ZPp1rFetGq+ZgM2c7R9K4DwRNi62TgyRH7q98+3b
    06175bW1hqOkI0YWOfAJYcFceq0AY/ii3/tFVullZwFAwBwvuK9I8FQGLw/Ezn70YyeuSP/11xum28sctxZ
    XFuBIy/e6j2I9BXbeC4Ps2j+RgKikspz19T+dAGlfQb7eN+Pmwp79OR/WitAR77V2xtIYMMD8KKAPn7w8DN
    Y7Sejjg81tqcMRzkjGOlZHhpQLUEkj5vz9q2IypvIhwMkk49qALE3/HoIUzkEfnmrWmwoEkmlwUQYRj3qtA
    vm3b5xgZyR2ParM7MsIhjBChecGgCneszyZBIDY7VTdQwO0YIOcZp73SmUrGV44LdcfSoiSsbMOWY55HIoA
    jVlWQ7o+nQUkkxKOCf1pMZI5zn161DIpOcHP0PWgCL7xODnPenDA5P0x1pqg55Iz29qeQQwz3oAWU5Ynjae
    1IeQCTgZzzTHyzZ5J9u1KQ3QHcB0xQA4AbdpIA7Go35J46evenKT7ZJ607yy2eAM0ARRv+8Qr+IFakOWjZg
    uMDuetZpj2sCuDjoK1lCrYKM/M7EUAZbqJFJUHzCeRUl3woQE5C4PY1c+yohGM5XjHeobqFt3TPbNAFKDcG
    A6DtmtS1JGAc44+prPKheDkH0q9aL8ozgelAGxayEEjuOPaoZ0JkYr396SNsMPfg5p8ZDPju3YelAFQP5Dd
    8dverOpaj5tnEso6c59P84pYYs3G9lDKo4zzmszV0aTK46vyfT2oA6jw8bSOwMs8gYsOAeCvtVi2W3+zyy2
    kiNg7thOQOOc1w7Xjafaxrb5jZj97qOK6LSrhJ9OX7OCrnLOSuNx9qAKF34VOpwzrIyBZc4yMnPavBPGWgP
    4f1l7WYkr2YDj6V9TWkU00Pms585RwAOTj6V498XdLN5ePK6nzOvHf3oA8himQZDDNSwrbPbzFiRIB8tNNi
    UkKPx6MeM01rKRUZlUso6sO1AFYqw4xkH0p8C5fJIz6U+JCD79qvW6KXQ3EYCgduKALujK0M0TbgzMfug4A
    +texaFqsaqlvJNGGUEl93zZ/LkV5A9qoiNxaZaMdUJ+YVp6FfIZlchgU+8w/woA+hrC4hk06K6jz5tvxIv+
    z2bJ7V0/ht/Mu2jUfK6EqvTHc/59q808D3+Z2iyPKmUrsbuPp6V6d4e2rq9qYyPKlXCkHnHTFAG9aEFwh+g
    ootvlu5F6FSRRQB89eGmVrCN+xrViYLdAnoFwB9a5/wdNv8O2zll6Z9ea2rBhJNMCQ4Vc59aANuzj2Jk9XO
    Mep61W1CRTctaKxRScO2f0qx5witFlyM5IGTjB6VjXqeYwOck85HqaAG3jIH8qHBiXGOM/jTI5MqFxjtSRw
    ksN+BgcDP+eKkCEBRxgnpnrQBCAS3Qg+uaa0TOpIyOnfrV+PY4JdRkDjNCorc42nHagDOSNsNnlv0p5TD85
    4GDn0qyyAcfdX0HeklB8yMgr5e3lSDnPbn+mPxoAr4APPANPdQMMD+QpJGUOBnNKXOfyGD60AN2jOakCgLn
    b265pm8hhg/pj9Kc0hOccfQUASJsUYbvxtNSXh32kDI3Rj+NVUbPQ8GpJHY25GcbWyM/lQBI8byAMXwSO1O
    mSbBJMch9c4xUUMucIyj0B96ZK5zknqOB/8AWoAIYWYDK8nnhquwo4iXIPX1qjbFlQnp9RV5nwCSTgdBj1o
    AsJ8vpz61XV2e4BBP/wBehSGBAwB+ZqCJ/wB5hmPJH4UAb0PyGTlSeDzVS5XznJVSRycH6UqyMSwQdhziq0
    108T7CTsPuB6UAQywJMEFxnABJz1BrT0JFku0hUbdp+UHpWbcs7qGRjtxjI5rLs72YaispL/uz97dj8qAPW
    JJGsiizInTGRxgVyHjLTLfV7WRbmRY0YZG0c5FRC+mu45PMuJCXX5SeSKxvEss8NnG2ZDgA43cjHfFAHj/i
    PTobW5doJTKqNyCeR61l22qIp2uAsWMeWOjfWuk8WW8l5uujGFZuG2LjJrgZSYXO/nPSgDq7CwttRiRjLHG
    +SCB1A7Gl1jQ7mzu9infH13g5H0rmYLmSMExs2Wxzmuj0fWXgtJUOGUDO1uQTQBXRpBKsUXyZOGGcbq0Vtp
    beUSwGVYmOCccZqOxMF/dpJny2LFm759q6/S3iljNm8x+ySn94qgEj3FAHRfDvUYWuAbwKojHysTjB9q9d8
    GuJbn5JA6QvkP14bkAfrXgeoaZNpMcEtk+
    +GTmKQc7vY+lew/CS7M8C5XaW7Djnr/jQB6OyhbyVjxvG7k0Ulw6oFk5ByUJ/Uf1ooA+XPBcpTTkiIwQueK
    63SwFimkJA3Njj0FcfoKeVaoRyVHb0xXaWSDyYIVI+dQfzNAC38pEFnCRndmQ9s81ErbstgZPGegpdQO+TK
    HkEoPaktlJAJIznjPagB20cHGOcdfpT3ACk5wO1DMEU9yeOKhkZnOWOMHGKADeB6kAVF5zAkKR9R2oOQATz
    7mmhQpwGG7qMUAOyxwWJ65+tEhJfnINM2behxwecYpW4ckc/QdKAG7d2cd+DQwy2B271JtJJJP504puIABo
    AiQAnpn696d9Mn0OKkEbc5G0D0pfKYg4H6dKAIB1557U+AAkhlHI5x2p3kkgZzjsTTDlOSSFPpQBGZFjkVi
    reowM/me1RrlskjOfSnzlZJREgAweWqysEShED5x1xQBEpYKM5BxVjI5JzwRxQYY2Y4bjvkU8RjgggY56da
    ABSSflycihYg0wOGJxySOamjUAZVh78UqHJwGHv70ATwSFQ6rjdgdTVLUAF2sy8AdCKsEbWLA9O+aXUXEqx
    hxtzwCKAK9rKkhKysdhBHIpItPLMzRkK65y3r6HHrRawYJA5961LCJi8qryWHbpn1oAyIJzCxWRk3Hr7/lX
    XW2mWN7pLyxtm7Uf6tm4we1Ykto8c4Yqrpzg9cmrlnc/ZowkqFXx1Hf2FAHGeJPDvkvO4CiNz82SMGvJvEW
    mrFO5c8ZPAHSvo67jttSsJbUB422kop5Vj6A9q8n8S6eomkhMaNMoGcklsev6UAeQZEbsvPHSrFtI7ttGDx
    nmrmtabKrtIAfrjisVCyMQMg9OKAN+2uXtblSrbGHUgZ4rudJaG+2ssqwbvmIJA3nvivL7eYLwc5P6GtSzu
    Xc7GJ4PVe30oA9ct5pLm2MMjSGNSWAx1x/KvQ/hUwjvLUKMBnHftg/p1/KvM/BT/ANoI0LyEXBH7tg2PMGO
    c+/vXpHw0kI1O2glD5wxBx6cfz/nQB6xcRkW0uc/JJn69v60VYmUsk6AHc6qQenf/AOtRQB8t6VH/AKMmCO
    QABXT2KE6pISMCKPnJ6YGKwdGQgwJnqQMY6V1NkuyC4n43SybB+v8AhQBHKhZAQMfN1qGV8EqpXBPJXpV7U
    MJH5KEF8ZJ9B6VQRMZAA57UAOUArjPHJzTSoAzjIpVGGYc4PUY71OF3gEDnpigCssY4yRSbeeFbPfAqwU4I
    wTjgihUO09BigCsy9sfXApyp+8xjr1zUgXlTjI604KA3IyaAItuXJH5Zpw+91P4il6EFsnHtTWIJPI57UAP
    UknkE4PFJgn1x/OmFmYEdPTikG5htGckYxQA75sjPpwCaSUbuRgkcde9NVW3ZPHalwFKnceO1AEkKogMhjB
    Y84qNZSZDhUHPYf5zTY5yJXJwo25Oe3oaVcADac9yR3+lAEomIA+Vcntt60oJJ3bAOnOKgaQ7jnO319Klbb
    ggEbuOM8UAOZx12rg59qW3ycHkDPHelVRIuGzg9KdattPO3Hp60AWgmd24+mMjpWfqrsAu7cQpwML1q84cg
    bSRzWRqfIDN2OMZP50ATpebFQRthWGc4xg/1q7Z3pTcV9epI5rnYpGLjH3OwrTtl3W24svJJAPegDbM5EQP
    IPJAHNSWVwso3lAcnncOn1rHg1HbKYnj3gDkj+f8An0q1EZYoi6gjJyGXuPegDesJl80K4yQOOOlYnizQI5
    2S5jAR1OA6DJx/n61VS6kLK6MSV7Doa0rDX8P5cwyo6MR09qAOA1zwzG1qHjkDpNn+Ho1eW+IdCm0+YsyNt
    z8rBeD9a+rptCsdQskmClUfl1xkHPpXGeKPDltJYtblXmTGAxX5l+tAHzKvDEHrnvWlprFSJCAMHv8A41f8
    S6F/Zkm5QQhYjrnH1rIjyoOCMdcE0AdnomovAw8gKspGAck4/wADXufw0uRd2yXwys8R2yg9Rk5LY96+cLG
    bdsdTtkBwR6n1r2j4U34triDzXbFzmNwe4PSgD6PlZMRuuBvjBHvRUcRC6Nasf+WblMj6UUAfNmiruliGOg
    zXTgiKCPIJSNskep6Cuc8K7TIz8ARoW/GtrUH2Q28ROSw8xse/AoAbuMhLPgsxyTjiokySB07GpolyBu9eK
    GBJOMY7CgBgUjPXIp4YqM5+Xp9aWIbuuMevvSucAjt25oAA65+nfHWmtKBngc8YqHeR09KapBOMYJ9TQA/e
    TzxSNJ83A/8ArGmkDg9TkimkBmwTk0AOLfMdoIbPUUm8A5B496gLYbAOT6A4oXAlPGR1BzQBMpOMn5fTvQM
    F8kDPc01W+UkdfTtSkHAJXAoAkc9O5Heq80u1cqTnpn0p7khfXmqxHmPnr7GgB8EZdWyCdw5wP0q0qYGcEL
    3pLcS4OdwGM+9W1Mp/iGSMgUAUJAQ24Dp2pxOD83Xv6fSn3BbPBJPfjvQhO1flUn0oAdGxA4Azjv2pY5AJz
    0Oe/vTipHJUEYznOKZINzLhQSOeO1AF5psKCPpycmse+JeRRJIVX0xVt9wH5DOKyb2Q7l6k896AI0cGZlBI
    VRyfWr+mwiUyOxOEOCOxFZEBZ2JdcgnOBxV2OcrG6qSFPXHQ0AWvNjaeRIzsVj97FWoyUlEU0hZWHDen4Vh
    Jl5x82cdgc/TPpWo8gcgc7gNuccj6UATi08osQyNE55K9E/CiSCKErL/rYyed3I/KoIrjyT5UjcZ4bt9Ksb
    92EZ12noCKAOs0bX4PuAMQhwC2QB9K27qO11NfOlb5JOHB6H6155DDCIso77d2SM4Of8K6KyuttkscDDrn5
    vvEUAeYfEnQJdNu5opkEkbfPG2eNp9vyryG4gNtcyRNx6e4r6D8Vs9/eBJoxE+MBSODx71414t04wyebEMq
    hKsMYx+tAGZbRDy2KEnGCeOlek+BtQAt3UMwkQDbnovv/KvNdNmKSkyNtDDb06j3rr/DpaG73RuPmG3aPSg
    D678EXw1PQIXLYaZATjsw60VwnwS1hZ49Q09ny1sFlX8eG/Uj8qKAPNfDu/7M5U/66UIMDBAHX9c1q3Mwmu
    S5PBGFz6dB/KqWioUtgmOYUxkf3zz/AI1ZYBZcL0xx+tAFoOQAcgjHr0qZXB9sGqBkCk5OTjgelOVsjJPbk
    UATO+3O08UzeWQ/McUhO4H+9jjPWmo3GT16c0AOJzuxk+o9abuGeTRnjPftg8mmH6GgCTfjpjnPHc0Egk7e
    vYnpUfGeQTmnAgnJ4wTQBFtYvyfbikVQMlsZ+vWn5Bz6n1oYDHJH5UAOVvlJ7UxmJcDr7Um8AZ6j3pGPUbg
    AeuKAJGGWIYgd+vQU9cAHGCOnFVQcE4AOOaZI42k4PB5460AWhONjbhjHcUxZiAdpxx171XjUnO7inoMAAD
    J9KAHJIzEqWyCfTrVlMqoJYgDgk85qnuCvjnnHWrKyBh8pI55HvQBOsrrgE7uDwO1PgOZMjPuKgxuOcZ/mK
    VHIJPAZaALUwBBA579ea5vUM72CnNajyuwcMTkDIGaw5rlstgg/MeozQA6GT7PuznefWp7V1ktzl/n+uKzZ
    L1WkYPHtA4G3+dPtyn3UYbgOVA5oAfa2X2W6upwTuuWVzn+HAxgVrWlwGgPmblx/F6e9ZNvKcnLgqR/e/wA
    +tWra4SOMxsByM8mgC2XWdBgjeo9eoqS1mV5QkyqojGAfX2xVFdjEvgDPv/Kop52eVNhXcp6Y/WgDo4bhZb
    V4l4KjIweSKZp8htr+NyxAxyM9ayRcG2CzDG4YBHc+n1FW47lXidcAHqMdKALXiHzWhjvIwrBG4dz92vOPF
    EkN75roVDcA7Rw34V2mpzSf2ZcfvQAhwyA9c/1rgbuJPmyGWNx8pJzgigDkE4nAyFKnAIrodNuzb3EbHPB9
    OfrXP3zMlxtZQSD96pYrx96ncGGMHjg0AezfCvxAuh+N7e5aT9zNFIsgUZH3SQPzxRXA6XrEgkVwkAMYxxG
    M0UAek6cGj01cctNIWYnr7U+5kCleCTgjHrSw4VSCcLGoz+XP61TuXL885NADy+88k/jU8TYzgj8apREYGD
    njuatRE9yf5UAWR029cd/SmnGMg/jTFfJK568Af57UbWbOSB346UAKe4PA69eKQYByOT70EEjAAb68UdsYy
    cZOfWgBSckbcjPfNBbGQxwf50hY47fiKY2eRyB3xQAE5Oc/nzg0jNnrkn2pq4APXryDxTiqLyzHaeSMUAJn
    jjtyTnrSMwBwScj0NLgychfwzSMjIcdPYjvQBGTz6Hpk0ip84bPI561Nt4yTz6U10IdSfyoAmRQy5JBamlU
    XIVunapIdo4+6R2p+0Fvn6457cUAUJBuJKnOPTgip1BUAsOMdv8/WpHjy/wAuOec09YDsG7OemRQBHE5R8Y
    wM55qU8dzz1NONuwi65z0zVW5JGFP1NADpmCwFl2DBzx1PFcnduYslzhST19a1rqfdE6pkkcfWsTWdwt1Bx
    j360AVzcBRtBKsO/tUkd0VaNgTt6n1rBluirHeGPvmi31Ehfl6Z70AdAkgViYiNu4nA7e1XIblTGMkBgfun
    uP8ACsWwVrllaTcBngYxk10n/CPyOiyONpPTHcUAUpLxhIpZQvPABNElwTLkOfnOcgfpW9beEZpImkEM3ls
    OuD1qG48LvBbMEciQ/wALc80AU7B45leNWLSDO0Hp096pfant5FJ+YHgAnBFRXNtd2Tb3jLFT1TvTDKt0sr
    SBjjr60AX7+5FxbZtlYkLkrXOFlmVoyh82JT8o45+lSytPZSFoizIwx65FZk1wZbpp0YrITnOf6UAY2roJT
    Iw+VgRwawY5CjnJOAa6nXrB1QTj+LJZPQ/4VyL5DHNAG7pd7hyQevX3orFglMbZJOD1xRQB9B3Mu2YQqcZ+
    Z/6VIgypbnGMnPU1mxu0ku8nLMxPqOtaMRUkAtgHvQBEVGQCoOOhqwinJzyD3PWlIBK/IoZePl/i9z71JgN
    jnHbgUAIjFMBevfB5qZW3LnHPvUeMdRz/AJ703OM49c4/woAe7ncf0HrTWYlQew/nQfmBP557UjKp6dMUAJ
    nJwMEdz70cgsRkcevanBRypGR25oI5IxzjNAESgM3Toak3MAFX8D3/AAqREzHhQCx6nsKeu2JcRDe2eWPb6
    UAJHbSsA5wB6k4p0i4yGbdxTss+CxzSbRn60ARrwQWxx1pJAHcdsdzzTmxkrk7hQoVn3K3UcccUABwMfX8f
    woZgoUKBu96cYjksRyOppjgg5z/jQAKf3gPr1B4BqzEQgPTk+marqDtJOPTGO9TEgnAznOeMUAOaTdu9c9B
    3qreqV2kjIx0AqwAvoMZpl2+AFIU4OKAOdvwu8KmQepIqs2nvfDb0Ud63RZh33uuB1was4VFAwAO+P8KAOc
    i8K2gbfJukPoTwa07bRrCGHaIEXJ9Kvkg8etNLHeOc9wPSgCotjaoCBFsUdMcZq7aLDGjIC2AcgAmmOjHJU
    nd78VGqsrc8N0zjGaAN7TtVl0+Ui3kkRem0cgg1qy63LexCKdYXHcMgyfofWuVibB+7n3NXI8sASMH1oAvx
    6fZtK6zbgrcg9cfSoH8IRyK7QNEd3QgYardlKu35uVzUv9qC0kxEq/Kc/N3oA4bVfCN9YOr3kRaIn5ZFOV+
    h9DiuVv8Aw8yTOUUmN8lMDvXt1vr7TybbiKN06Hae306Vo3ug2N9Z5sSkR4IKDgfUdvwoA+W9WDu7FgRtOz
    b6Y71y97AVO8ZINe5+PfCMlhA08qg278+eo4Ps3oa8W1KIwvJGckf0oAyaKcwwcUUAe8WhwoGOcema1LdMk
    bck+1UbOIgZbA54HetWJQsDqACT3oATy/m2kUISvGOO/vUjsQoUbecfWoWxuBIGB370AKOR05xxSY578c57
    UYOOvJ9/1pRy2c89qAEiPXB+XP4VK2CSVwaaqZBwce2KesfAA5Hr/wDXoARRzx0PWnImVBJwMc4NTBP3bZJ
    x3FMckKewoAUNlNoAC56DvUJQDdyQc4JHrTskDlhzUI3Ak8tknpxigCclc8Yxj1pGJJ4P5c01hnnpjvTyRg
    nt6f40ARsnHPGevPNSLnkAgccYFMYkqOPbIqWAZIDA+tAEqHaOTmo2AYgcjuKlZThsZPufSom7nI470ANAC
    kYyevfrUvUjAG49R3qNXBCk9OwFSbS3IHPU+1AEqBF6gk5qk5zIWc4YHO01aw23GCT0/Cs+djuOfXqDQAsk
    r4HzY9eeKasm5AHPJqPqxHGRSgHHUcjnNAE4Xrz260+NMv8AMMKBxkdKgRiRgkdeeelWom9BkDoSKAFEe3L
    jIx3proSNw6Y61IpwSMAk8VIw64xz2BoAqBTnjI7/AP1qsRHGCPu+9ABGeST3qSNcsMfdI70AXbdsQswA2+
    4rLvnOz5QSP51oghYjGerHjFUJlBBB/nyaAK9hemEsWPA6EetdXo2oPtV4/wDgQzgcVwt2wt/3ig9+Kt6Fq
    v74jnHfLd6APSbya01LT5Yri1WSMjbLEeQ/vXgfxM8E/wBmTSXWnozWrMcDqYvb3HvXsVrcbAX2bWzkAd6k
    vLeO7tsSKTGw5BoA+Q7mBo2O0cUV3fxI8MPot81zaxn7FI33f7hP9KKAPR4I/wB7tB69qsMxUEA4GfoarxS
    HcjrwSOPensxZ/QE0ASSn52ZT8p6+9OQhlAyDx65pisCgwPpUoUAEKCB6DigBNu7helPRQG7n61IEwCGGKW
    Nck4B
    zmgBI1y+Mn5evHNOxjCjlScAf5zU4j2A5bBPFRyMC3AOc84oAax2g5zx+NROqlWLHOBx7U4EAkcjmmEEIDg
    n1oAQEHJzmhAADn1z9KVTld2CcdKcFyfrQAuASAMZxx71GQfmI4zVggE9cAelNWMnnkk9R3oAgUdDk5z0xU
    yjZkZzjjmpY4csB2FOaEE/KQO2O9ACM2UH9KrSMMncDxzwasOgUAYwO1QvEH6A9aAI0w2TjGOpq7GfkAOSS
    c/QVWiiZd3AyPTmpB91sgmgCc4bpwAOtZ0yHJyOPer0ZKodwPfkVDJGAA3ODxzQBRCkHJHFOChjnnnsalKZ
    zzgjvn/PFNSMhiRigCMAdwPbjpViPn7uc4z1prRHnaRzznsPanxHOBt59f/r0APU5yRwB7fSnAjjnBB6mhR
    83zEbfX0o2kdR8v060ASgbhyWP0HNORQTnIFMjAwQx4z61YwCeSM9TQBFKB5p446+1QnJGQOnPSr7xI5JJ2
    8YBpsNqpOC/HTPU/SgDFvollU4TIxggHpVSx0uWGZZFDBcg4K9q637OgPyBW4yAeOanjtHcANtVO/PWgCxY
    QfaYTt+Udya0YY0SIQ7iyD7u70/+tSWUYjj2qcj+IjtTbp9iEqSoU8+9AGD4o0yC+jaKeNZF4OMdeaK0b6Q
    PbLsOOc+lFAHnsUo8vy1BBHOfWrUWTyCeep7Vm2hJdn6sT+taKA79p7jge1AFhcFexz3xVhe3I6VEmAowuQ
    e9XraHkseQeOlACJE7jJ4UfrUjIqAANjt61IzHgEAKOPWo8c5PfOTigBJF3IMMpAHQcVBIQSBgDn9KkduPu
    niolOSc9c0ANA59vagxjb3wBTgpycfUGpGBxwDjHA70AR7QVIP05FO2nAIWpY1yMYH1BFOABO3v3J7igCJR
    t6ctipQm1SfXv3qUIOTgY9RUMp3AjAx6+vtQAoKhAVz9KesqhBgYLHvUW0lR6D2/lT44SV+9z246UAKxBQk
    9cd/8ajCqqcA5J781O0ZC7eAQKVU3KqnHP60AVUQjkE4OM5FOEanjn6VOFJl24OzGDQV+
    +wDZNAFOeQCVQowOlJvyvQccHNNljO8jI44J6U1VKkYz04INADiowNoHHUnvTMA9M+xx1qwmGGCMY5NOdDt
    +9yDxjvQBWHT9c0qpkkjHWpArAHIPTgU8JwBnjgCgCENt6/iR0/zxUq/MwHAGOeMU1o8Z5O6nKDkHHHSgBA
    CTknOKnViy7ScHjPHeosdc4znFCsyscAZHXmgCxz0JP1PU1NDGScbu361VB+bse1Xrc/JtOMfzoAdCGU4Y/
    L1BB61etiFYYbleuTVYZVSCOCPXrTlJDqVGPr1oA2IJQCVAGT7dKbc4dTk5AHTpiobcllIzlv5Ul3vBHzcA
    HIxz+FAFCVlVmjf+I5HfFFZ2pzHaSTyeOP8AGigDlrOArIgYFVY/pWhLbhsuGAPIB7j61k2VwvlAHBfbwD6
    1rWQaWGMEjDHPf9aAJoBjgHPGCcdavQnavYA9fWmiEQgBSGz1I70hdcEcADvigCSQ49SSOfamdQFZsDr8ve
    mMWI+Y5I6YoAIAyCMjP0oAQqScqT6H0qQqNy/U800qGJHPapFj35PfpzQAwDGOvXpipChLY685qWKHCZxyD
    xzzT3VcZB6UAQ7cjHTI9KQ4C7jwf88VKBzwdxxgkZxTCOgI59/6UAMYbkPbuKjKvjpkHnHoKtMg6YwM4o8g
    uNu0ccn3oAZFGSVH3R371cUZGFA4H5/SnJDhQMA4H+RT4gBnCk4HQ0AVpcBOmTk59qYFPccflU8imXaEzz6
    9qjeIFueCOh6UAOhiYEMTgKee9TKhYNtPX/P4UqRkkYwPapsdXfGV7GgDHuoQW3/hgiqrKeFHygDPHpWzIq
    sSDkd8elVDB82QTxz+PvQBQUYbODjH0qYseOQckYINPEfHQj8KYMISjAAZ4oAkCHd1HB4FIq7hyQPbPSpVw
    QeBg4qfZlQVHQfp6UAVGTdy4wwwaayZUAdTycVY24kAPpnpwPakOFPfBP4UAQMgAXg/h3pMAE7Tzn+nSpW4
    AxtJ746VVk3ISVOQfUUAND/NwefUd6upMFAxknriqaNkZY5NTKoaLDYz6+lAGnBKJYhjryOuRVmI4OOMjrn
    vWXp+EyvGc5z9e1aaKGjJPVfw4oAvx8J0HPoaiuCTGxCk8dfpTYpSpHzc+g7VFcyDackYxQBz2tn/AEcZOC
    T1FFM1UqVO/lPpxn8aKAPB7bxfqSTBwIC3uhP9a6Ox8faqFjPlWeT1+RvT/eoooA1IvG2qOnKWoyM8If8AG
    tK38TXrNt8uAAjsG/xoooAux61dMSpEWAccKfT61ch1CaRju25x1AoooAtW11I78hRlyvHpWibhxGrDHX0o
    ooAek7DbwOCaX7Q5Xnb94r07UUUAPilLryF6Z4qcnjOBwQKKKAGxOS4BAI6VYhbA5wee9FFAF2HAAOB16UN
    gkrgYziiigAgRSGOOTlc0ioAUHUc9e1FFAD1GQ54BzgYHSiZAIJGHByOPzoooAhdAYxknnrVWeMBuCeVooo
    Aqt/rnXHG0GmOoY8jrRRQAttkbRk8ZxVkMcN6DjFFFAEQAZzkd6SM/Ow98UUUAGAMnvmqkwGRnn60UUAN2B
    Uyvc4ox8hGewoooAltThT9Aa2bXm3QnrnFFFABPwRjvn9DVSaRlwOMHrRRQBzniGZliBGOtFFFAH//Z);\"
    >",
    " </div>",
    " <div class=\"lgnd\">",
    " Bilateral calcified pleural plaques due to previous asbestos exposure and a
    right-sided malignant mesothelioma. Chest radiographs shows multiple calcifications
    en face and in tangent, along the rib cage overlying the lung and along the
    diaphragm. Complete opacification of the right hemithorax with contralateral
    mediastinal shift is due to the pleural effusion associated with malignant
    mesothelioma.",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " Courtesy of Paul Stark, MD.",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6352=[""].join("\n");
    var outline_f6_13_6352=null;
    var title_f6_13_6353="Gestrinone: International drug information";
    var content_f6_13_6353=[" <noscript>",
    " <div id=\"javascriptDisabled\">",
    " It seems to us that you have your JavaScript turned off on your browser.
    JavaScript is required in order for our site to behave correctly. Please enable
    your JavaScript to continue use our site.",
    " </div>",
    " </noscript>",
    " <div id=\"printHeader\">",
    " <div id=\"printHeaderLogo\">",
    " <img alt=\"UpToDate\" src=\"./../images/UTD2_masthead.myextg\">",
    " <img align=\"right\" alt=\"Wolters Kluwer Health\" height=\"40\"
    src=\"./../images/logoWKH.myextg\" width=\"175\">",
    " <br>",
    " <div id=\"printHeaderText\">",
    " Official reprint from UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " <br>",
    " <a href=\"file://www.uptodate.com\">",
    " www.uptodate.com",
    " </a>",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </br>",
    " </div>",
    " </br>",
    " </img>",
    " </img>",
    " </div>",
    " <div id=\"printHeaderLinks\">",
    " <a class=\"TOPIC\" href=\"#\" id=\"printHeaderPrint\" rel=\"19\" title=\"Click
    here to print\">",
    " Print",
    " </a>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a href=\"#\" id=\"printHeaderBack\" title=\"Back to normal view\">",
    " Back",
    " </a>",
    " </div>",
    " </div>",
    " <!-- TC:TOPIC_PAGE -->",
    " <div id=\"topicContent\">",
    " <div id=\"drugTitle\">",
    " Gestrinone: International drug information",
    " </div>",
    " <div id=\"lexiTitleImg\">",
    " <img height=\"17\" src=\"./../images/lexiComp/Lexicomp_2012_71x17.myextg\"
    width=\"71\"/>",
    " </div>",
    " <div class=\"clear\">",
    " </div>",
    " <div id=\"drugCopy\">",
    " Copyright 1978-2013 Lexicomp, Inc. All rights reserved.",
    " </div>",
    " <div id=\"topicText\">",
    " For abbreviations and symbols that may be used in Lexicomp (",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?23/39/24183\">",
    " show table",
    " </a>",
    " )",
    " <div class=\"list fbnlist drugH1Div drugBrandNames\" id=\"F4304051\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " International Brand Names",
    " </span>",
    " <ul>",
    " <li>",
    " Dimetriose (AU, IE, PT);",
    " </li>",
    " <li>",
    " Dimetrose (BE, BR, IT, LU);",
    " </li>",
    " <li>",
    " Florizel (GB);",
    " </li>",
    " <li>",
    " Nemestran (AR, CH, CZ, ES, MX, NL)",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"list_set htclist drugH1Div drugBrandNames\" id=\"F1978908\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Pharmacologic Category",
    " </span>",
    " <ul>",
    " <li>",
    " <span class=\"list-set-name\">",
    " Antigonadotropic Agent",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"block iuse drugH1Div\" id=\"F1978911\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Reported Use",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Treatment of endometriosis",
    " </p>",
    " </div>",
    " <div class=\"block idos drugH1Div\" id=\"F1978907\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Dosage Range",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Adults: Oral: 2.5 mg twice weekly starting on first day of cycle with second
    dose 3 days later, repeated on same two days preferably at same time each week;
    duration of treatment usually 6 months",
    " </p>",
    " </div>",
    " <div class=\"block prod-avail drugH1Div\" id=\"F11821171\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Product Availability",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Product available in various countries; not currently available in the U.S.",
    " </p>",
    " </div>",
    " <div class=\"block foc drugH1Div\" id=\"F1978910\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Dosage Forms",
    " </span>",
    " <p style=\"text-indent:-2em;margin-left:2em;\">",
    " Capsule: 2.5 mg",
    " </p>",
    " </div>",
    " </div>",
    " <div id=\"topicAgreement\">",
    " Use of UpToDate is subject to the",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_in_page\"
    target=\"_blank\">",
    " Subscription and License Agreement",
    " </a>",
    " .",
    " </div>",
    " <div id=\"topicVersionRevision\">",
    " Topic 10387 Version 28.0",
    " </div>",
    " </div>",
    " <div id=\"footer\">",
    " <div id=\"supportFooter\">",
    " <span class=\"sfInfo\">",
    " &copy; 2013 UpToDate, Inc. All rights reserved.",
    " </span>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_footer\">",
    " Subscription and License Agreement",
    " </a>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Release: 21.6- C21.56",
    " </span>",
    " <br/>",
    " <span class=\"sfInfo\">",
    " Licensed to:",
    " <span class=\"emphasis\">",
    " AsanBook Dig. Med. Lib.",
    " </span>",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Support Tag: [0605-91.202.164.29-5B3EA195B2-S244013.14]",
    " <br/>",
    " </span>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6353=[""].join("\n");
    var outline_f6_13_6353=[" <div id=\"toggleOutline\">",
    " <a href=\"#\" title=\"Collapse Topic Outline\">",
    " <img alt=\"\" src=\"./../images/orange_arrow_left.myextg\"/>",
    " </a>",
    " </div>",
    " <div id=\"innerOutline\">",
    " <h1>",
    " TOPIC OUTLINE",
    " </h1>",
    " <div id=\"outline\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F4304051\">",
    " International Brand Names",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1978908\">",
    " Pharmacologic Category",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1978911\">",
    " Reported Use",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1978907\">",
    " Dosage Range",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F11821171\">",
    " Product Availability",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1978910\">",
    " Dosage Forms",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " <div class=\"openRelatedGraphics\" id=\"DRUG_INT/10387\"
    rel=\"outline_link\">",
    " GRAPHICS",
    " <a class=\"graphics_icon\" href=\"#\" title=\"View All Related Graphics\">",
    " View All",
    " </a>",
    " </div>",
    " </h1>",
    " <div id=\"relatedGraphics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <div class=\"openRelatedGraphics\" id=\"DRUG_INT/10387|TAB\">",
    " <a href=\"#\" title=\"TABLES\">",
    " TABLES",
    " </a>",
    " </div>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?23/39/24183\"
    title=\"Lexicomp clinical abbreviations\">",
    " Lexicomp clinical abbreviations",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " </div>"].join("\n");
    var title_f6_13_6354="MRI pontine glioma";
    var content_f6_13_6354=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=PEDS
    %2F75202&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=PEDS
    %2F75202&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\" style=\"width: 516px\">",
    " <div class=\"ttl\">",
    " Characteristic imaging findings of a diffuse infiltrating pontine glioma",
    " </div>",
    " <div class=\"cntnt\" style=\"width: 496px; height: 328px; background-image:
    url(data:image/jpeg;base64,/9j/4AAQSkZJRgABAQAAAQABAAD/2wBDAAYEBQYFBAYGBQYHBwYIChAK
    CgkJChQODwwQFxQYGBcUFhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChM
    oGhYaKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wAARCAFIAf
    ADASIAAhEBAxEB/8QAHwAAAQUBAQEBAQEAAAAAAAAAAAECAwQFBgcICQoL/8QAtRAAAgEDAwIEAwUFBAQAA
    AF9AQIDAAQRBRIhMUEGE1FhByJxFDKBkaEII0KxwRVS0fAkM2JyggkKFhcYGRolJicoKSo0NTY3ODk6Q0RF
    RkdISUpTVFVWV1hZWmNkZWZnaGlqc3R1dnd4eXqDhIWGh4iJipKTlJWWl5iZmqKjpKWmp6ipqrKztLW2t7i
    5usLDxMXGx8jJytLT1NXW19jZ2uHi4+Tl5ufo6erx8vP09fb3+Pn6/8QAHwEAAwEBAQEBAQEBAQAAAAAAAA
    ECAwQFBgcICQoL/8QAtREAAgECBAQDBAcFBAQAAQJ3AAECAxEEBSExBhJBUQdhcRMiMoEIFEKRobHBCSMzU
    vAVYnLRChYkNOEl8RcYGRomJygpKjU2Nzg5OkNERUZHSElKU1RVVldYWVpjZGVmZ2hpanN0dXZ3eHl6goOE
    hYaHiImKkpOUlZaXmJmaoqOkpaanqKmqsrO0tba3uLm6wsPExcbHyMnK0tPU1dbX2Nna4uPk5ebn6Onq8vP
    09fb3+Pn6/9oADAMBAAIRAxEAPwD5+
    +IOoXq+PfEqrd3AUancgAStgDzW96wP7Svv+f25/wC/rf41q/EP/kf/ABN/2E7n/wBGtXP0AW/7Svv+f25/
    7+t/jR/aV9/z+3P/AH9b/GqlFAFv+0r7/n9uf+/rf40f2lff8/tz/wB/W/xqpRQBb/tK+/5/bn/v63+NH9p
    X3/P7c/8Af1v8aqUUAW/7Svv+f25/7+t/jR/aV9/z+3P/AH9b/GqlFAFv+0r7/n9uf+/rf40f2lff8/tz/w
    B/W/xqpRQBb/tK+/5/bn/v63+NH9pX3/P7c/8Af1v8aqUUAW/7Svv+f25/7+t/jR/aV9/z+3P/AH9b/GqlF
    AFv+0r7/n9uf+/rf40f2lff8/tz/wB/W/xqpRQBb/tK+/5/bn/v63+NH9pX3/P7c/8Af1v8aqUUAW/7Svv+
    f25/7+t/jR/aV9/z+3P/AH9b/GqlFAFv+0r7/n9uf+/rf40f2lff8/tz/wB/W/xqpRQBb/tK+/5/bn/v63+
    NH9pX3/P7c/8Af1v8aqUUAW/7Svv+f25/7+t/jR/aV9/z+3P/AH9b/GqlFAFv+0r7/n9uf+/rf40f2lff8/
    tz/wB/W/xqpRQBb/tK+/5/bn/v63+NH9pX3/P7c/8Af1v8aqUUAW/7Svv+f25/7+t/jR/aV9/z+3P/AH9b/
    GqlFAFv+0r7/n9uf+/rf40f2lff8/tz/wB/W/xqpRQBb/tK+/5/bn/v63+NH9pX3/P7c/8Af1v8aqUUAW/7
    Svv+f25/7+t/jR/aV9/z+3P/AH9b/GqlFAFv+0r7/n9uf+/rf40f2lff8/tz/wB/W/xqpRQBb/tK+/5/bn/
    v63+NH9pX3/P7c/8Af1v8aqUUAW/7Svv+f25/7+t/jR/aV9/z+3P/AH9b/GqlFAFv+0r7/n9uf+/rf40f2l
    ff8/tz/wB/W/xqpRQBb/tK+/5/bn/v63+NH9pX3/P7c/8Af1v8aqUUAW/7Svv+f25/7+t/jR/aV9/z+3P/A
    H9b/GqlFAFv+0r7/n9uf+/rf40f2lff8/tz/wB/W/xqpRQBb/tK+/5/bn/v63+NH9pX3/P7c/8Af1v8aqUU
    AW/7Svv+f25/7+t/jR/aV9/z+3P/AH9b/GqlFAFv+0r7/n9uf+/rf40f2lff8/tz/wB/W/xqpRQBb/tK+/5
    /bn/v63+NavhTUb1vFGjhry5IN5CCDK398e9c/Wt4T/5GrRv+v2H/ANDFAFr4h/8AI/8Aib/sJ3P/AKNauf
    roPiH/AMj/AOJv+wnc/wDo1q5+gD6X+D/wtsNa+EUx1HR4bjWPEIuWsL2RkDWYjXERAJz88gbp1GM8V81yx
    vFI8cqlJEJVlYYII6g1qf8ACS619p0y4GqXgn0tFjsnEpBtlHICf3R9Kzbq4lu7qa5uZGlnmcySOxyWYnJJ
    9yTQBFRRRQAUUUUAFFFFABRRRQAUVas7C6vXC2sEkh9hxXY6J8Prm6ZPtkjKzdIoV3sfbigDhQM9K19P8N6
    pfxh7e0fYf4mGBX0h4E+AlxceVcTWiWMWMiW6+eQ/Re3417Hp3wr8LaTbrLqpN0yjl7hwqj6CgD4ktvAl9I
    P3lzbI390Ek1rWvwt1CbpJM/f93bk/1r7Lk8WeANAJhgezWRONsFqXP/fQXH61lT/GvQYHK2+m6hKB3WML/
    M0AfKY+EmohSzR6hj1+y8fzqjcfDW5h+9NPH/10hx/WvrBvjzo6MBJourKD32qf5Gtez+Mvgu5jBvLme0Y9
    VmtZD+oU0AfEtz4Hu4x+4uoJD/dJINZN94a1WzQvJasyDqU5xX6DWl74E8WwkwSaTdg9QVCN+RANZusfCDw
    zfoWs45LKU8hoiMflQB+eZBUkEEEdjSV9W+PvgPdwwzTwQRX8IyTJCNkqj196+efFPhG70VmkjDTW4OGO3D
    R/7w/rQBzFFFFABRRRQAUUUUAFbfge3hu/Gvh+2uo0lt5tQt45I3GVdTIoII9CKxKmtbia0uobm1keK4hcS
    RyIcMjA5BB9QaAPpT4yeGPDzeDPGcmiaZof2zQ9RiXdY2Etm9pCzlCrsw2TknA+XgdfSvmWuj1/xx4p8Q2Q
    s9c8Qapf2gYP5Nxcu6Fh0JUnBIrnKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiig
    AooooAKKKKACiiigArW8J/wDI1aN/1+w/
    +hismtbwn/yNWjf9fsP/AKGKALXxD/5H/wATf9hO5/8ARrVz9dB8Q/8Akf8AxN/2E7n/ANGtXP0AFFFFABR
    RRQAUUUUAFFORWd1VFLMTgADJJr1D4dfCrUvEd3GjW0kkhOfK+6qD1du30oA4HRNEvNYm22yYjB+aVvurXs
    3gD4NX2olJLaya6J/5eZwUhH0PevobwH8ItG8MW0VxqhiuJ4gH242wxY74PX6mk8Y/Grw7oDyWWkJJrF/H8
    vl22BCh95Dx+WaAM3w58DbG1CPrF8ZD1aG1Ty0/MYJ/KuvubrwP4AhWOQ6bZXCrlYxta4k+g+8a8H8S/FXx
    Vr+Y3v00q1YYNvYL85HvI2f0xXM2SsYylovlvIfnk5Z2+pNAHrvij403c6yQ6DZGxjJ+W4ueZSPaPGB+Zry
    3WfE97e/vb6a5vpc8NcyM4H0U5A/CmRaFMJgWbK9at6npX+hEjoBzgUAZdjrkhbgBj02KNuPyrWMksqZkYA
    nnljWBY24gu1RyA3Ymu9g0/wC0WIxjd2NAGWkKmFRucsR1DkVnNMYZxDO0gDHAJYsD+ddHZMIJxDLgHOBmr
    d9p0MxBdQ3ccUAc1d6TCsYkaGEqed3kqD/311qfR9V1nQ5Ul0jV9Rt0XkRid5ofxQnbV/xDJ9i0z90cHGAB
    WPbXDW9sjzpjI5oA9d8M/GVAscHieyZAAA17a/OhPq64+X8Ca6nxH4L8N+OdMW8sWtg8o3R3tptIf644avn
    e5t1uYBLYzAS9wT+lU9D8Va94F1Zb/SQPJYgXVs4JSUe49fcUAZfxY+E91pF62IlhmwfLZFxHOPb3rxO4gl
    tpnhnRo5EOGVhgiv0J8I+MvDHxU0OS2dVW4A2y2kxAdDjqvqPcV4F8dPg/d2Di7s9skQJEU2Mbl/uv6H0NA
    HzdRUtxDJbzPDOjRyocMrDBBqKgAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiirdtp17dIXt
    bO5mUcExxMwH5CgCpRUtxbzW77LiKSJ/7rqVP61FQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAVreE/
    +Rq0b/r9h/wDQxWTWt4T/AORq0b/r9h/9DFAFr4h/8j/4m/7Cdz/6NaufroPiH/yP/ib/ALCdz/6NaufoAK
    KKKACiiigAp8UbzSrHEpZ2OAo6k01QWICgkngAV9Cfs/8AwfuNcu49T1SNo7JOWkK/
    +OL6n1PagBPgV8G7nW737dfkxQR43TbchT/dX1b37V9LavrHhr4XaBFbogEr/wCptIyGnuW9fU+57VmfEDx
    5p/gjTk0bw9HbSaoqbUgX/V2q/wB+THT2HU189zanc6pqUs1xdS3d7Kf313L99vYdlX2oA6rxl401rxZvXV
    Lh7Kw526bZyEAg9pn4LfTGK4JJTJO1pFbxQRf3Y1wP/r1vPEIWjDfdJxUp0os8kqKR3FAFaDQ45lUkEAckd
    K1dLjijuWiCgbegq1o0ojWWKQ/OvrVeGWKDVN0mAD6mgDWu9sdsSo5qxa26z2QWQZ3Dms/UH+0RlYSuDznN
    Z8WrXkEhijgeVFH3lFAFbxHo4iCyREhkPBroPDN072ADqAVGDmqRvfNiLTxNk9mHSr+mBG0yR0wMg9KAOa8
    RaoseoxMMDDYro7G7+1pGVYEn0PWsH/hE/wC05fOndhzx7Vu6ZpEWjRM4l3ADjJoAqalEbzVIopOY0OSPWp
    9U01LgoAPlAyR61FpEgur+aYHKDgGteaZY4i3BI4xQBwc2myxXEjwsyFTnHYirQi+2x7Cv7wDjPU1uJLHcS
    AnHzZH1rONv9n1PaeFYcUAcTf6be6PqC6pocslpfwHfiMlWyO64/lX0f8I/iXpvxN0SbRteihi1mOPbPbtg
    Ccf30B7juO1eT6jbLcDaxxLg7WPf2rhb/TrqzvotX0h3tdTtZBIGTghgeDQB1vx/
    +EcmlyC908NJGQTHLjqP7je/oa+cXVkYq4IYHBB7Gv0E+G/jHTfin4QmstTSNNTjQJd2x6g9pFHoT+XSvlX
    47/D258L69NIkRMR+YuBgOvZv8aAPI6KKKACiiigAooooAKKKKACiiigAooqWCGSdwsSFj7UARUVqR6NMc7
    3Rcde9TR6GZABHL5j/AN1RQBi10XgjwlqPjDWo9P0yMnJHmSYyEHqalsvDE7AvJBMwHbbXbeHvGGqeB7dY9
    HtYraSXqxQbj9aAPXfCvwa8HeF4ReeIZTe3EYyRKflz9K6CL4p+B/D9qLe3limhDbTHFAV8r/GvAdX+KF7d
    CZr0/aJZRhkH3Qaz303TW0EytBcS6lcHIKjCgUAfReoWXw9+Ktu7sql0HyTRgo4z7Gvnz4tfCO/8GXXn6eX
    vtLkGVkAyyexxWfpXigeHrOSwmgkDDlHj+RlPvitaLx3r2u6cukx3EssLH/V/eJ/HrQB5MRg80leiX3gHVJ
    C9zLYPGp9eKxL7w9Bp6j7bcRRt/dDkn+VAHLUVtLYWk52wSKx9m5qhfWE9m+JUYL2bHFAFSiiigAooooAKK
    KKACiiigArW8J/8jVo3/X7D/wChismtbwn/AMjVo3/X7D/6GKALXxD/AOR/8Tf9hO5/9GtXP10HxD/5H/xN
    /wBhO5/9GtXP0AFFFFABRRXbfCfwPf8AjnxRDZWUJaFCGmkx8qD1NAHYfAX4XXXjDU1uJ4mjs4mBklI+4vt
    /tHtX018SfG9h8O9DttB8PxxNq7xBYIc8W6dPNk/XHqan8Qano3wZ+HiQ2MazXjfu7WAn57qY9zjsM5PoBi
    vmkzXmtavc6hqs3m6heyebcOOMn+6PRQMAD2oAkUT6ncSr5sskkrGSa4kOXlb1NWdOsW067KSMxz8wJ71ta
    bbx2tyhIAyMZqbX41KxMuNwPagB2p2PnWazRZ3AAitDSJQYAtwNpwBzUloGl09UIwoXkmoJJ7eO0xkFk96A
    MXxPNJaTCa1UtztO3vWbcpcXlzArKy5xle9dfFAbqOOSdNqg5C0+G3gGotLgYUUAM05Io4FRkIwMYbrV+J4
    kcDaAvc4xTXniDZVQxHcc1XlvhcKYYFVmbgnHSgDSBs5lbYY2x1rFjnAM9raAHBz7CtO3ihtYfKjUGQjJFQ
    2GnRrPLK4O9zyKAM1by+eRoLZeV4J7CodShvRasZZOvHHatzS4YzfXKAfJuA4pmvR+fLHbpwu7Bx6UAQeHo
    4LSzWIMOBnPc5qpctJNcSW+7jPBHpUt1aJA6eWHBx2NUNNllTWZFuUIRh8jYoA3LexjVEIBG2qN2nmavbr6
    A5NT6jezW7gRjep6ACoIrhBI00rL5x4xn+lADNVkiikwcYxzWZdxqYi+M5HNaptEnYzTgL3A7VXvp4khKgB
    jjAA6mgDktF1268B+LbXX9NUyRodk8WeJIifmH4dR9K+i/itodl8Qvh0mqaSyzk2/2i3kXqyFckf/AFvY18
    5avECzW864Drlc/wAq9c/ZY8TbrHUfBt8242m65tN3eFiNy+
    +Cf1NAHxtf2r2d5Lbygh42KnNV69c/aP8ACf8Awjfjm5aFGFvMxZSR2PIryOgAooooAKKKKACiiigAooqSG
    J55kiiUs7nAA7mgCxpdjJqF2sMQPP3j6CvUZfD1h4Z0iK41FfnkAKRDqfc0vhfS7Dwxpn9oaoV3LyEzy7dv
    wrmtV1i78Qa81xeOGjQZRM8D0oAr6or35YiNkT+FdwxiqunWFzb3HmL5cYHIJBNbSJ8uVwPWpju8snt9aAN
    Tw3401LQ7xGvVju7EkBxtwUHciuk+K97pHiEW0miqiFYtzkDBJrgnjRsAfMrDBrb+HWmxXdrqZkY77dWUAj
    ORigDzF5LeJ2RomZg3LE121h4hnl0+yj3hREwxxziuSmtRNe3sf8aOcVc0yL7RP9m43Iu447UATeN5LWbWT
    LHM3zrlh711nwcvbPQdfttS1S2a4tHO0H+4fWuA1CHEskuwt2HevYfA1jB/wpzULm4i8yRSSjEfdNAFf4k+
    OrnWdXutP0fMOno/zSDq1cNdWBuE3M0rehZgaNOYLZREfef5zV6J2lPORjsKAMKDRZRIzyeUAOVJGf5V1Oh
    S2d/Omla6qJHMNsVwBwp9xUJUHpx61la1EBZu6Fg0fzAigCPxr4KudBum8v8AeQnlSvRh7Vxx4PNekWfihz
    Z20Ors09mwC88sh9RWV4v8ObF/tDT/AN5bsMkryPrQBxdFFFABRRRQAUUUUAFa3hP/AJGrRv8Ar9h/9DFZN
    a3hP/katG/6/Yf/AEMUAWviH/yP/ib/ALCdz/6NaufroPiH/wAj/wCJv+wnc/8Ao1q5+gAooooAfFG80qRR
    KXkdgqqoyST0Ar7v+Bfg63+Fnw1k1DxE8VtezL9qvZHIHlL/AApn1HH4mvn79lXwAvirxqdYv4w2maQVlIP
    R5v4B+GM/hXqH7T3jb7RdReD7FsxKVmvWHduqR/1NAHl/jvxpeeNfFtzrNyClvGTFp8H/ADyi6A/7zdT9fS
    m6FBMrLJMGQk5BPQ+1Z+i6VJNMrFeFP4Z/
    +tXeJZLHp6q3IVevvQBBdxSvECjYYc1JpM0jxeddgMEODSWjSSzLEH3YHI7VPPaS28uCN0En3gKANB9QWaM
    RxqcHoqjj8ahi0xfmmnbDe/QVcsxbpYhucjjbWVqt5LeEwWxwAMMV6CgC5PqIaFUtSGPQtU0FnPMqqd21hn
    AHJNS6RpMNtaI0x2gc+5rpdOsrm/ULZwiO3H/LRuPyoAzYLCJE+d1XjGKqxWFva6oZvNUwuOnoa7u08PWUK
    A3A85+5c8UT6TpLMPNihA/CgDlLa2hlvHl8xcHgDNSvGkMR24bnjmtm68Pae6/6Nc+S3sazX8L6huxBfQtG
    fUYP86AMXSYmgupGY5EhLc9qkS3MwabOG3Z5rSk8J6og3pcRSMOg6f1qFdJ1e2j2tbM2O6sDQBn3K7zGpOS
    TyaS+tFaL5Rgj0qOe5Nve/wCko0ZUdHGKkilmnYOP9WfWgChDKyXCpcrgDoTUc1mrXbSxoGY9z0WrGtNG0W
    2MZk7euajsnmhiVHViepyaAJGsDNHl5Wb2XgVQs9KWO4e4cnAPAJyAK2EcorHGARkCs1HmuYykQzg/MxPSg
    DjvG8sZZTEf3kZzxWJ4c8Sz+GfGGka7bZ/0eUGQDo8TcOp/Amu9vfD8Lh5HGXdSDnnmvNL60WGSeJl4jO4D
    /Z7igD6H/ah0KDxD4Dg1mxAmCoHSRBnKkbgfyzXxPX238INXTxp8LtT8L3RD3unReXFkZLxEZQ/zWvj3xhp
    b6P4kvrN1KmOQ8EfpQBi0UUUAFFFFABRRRQAV6V8MPDmLG78RX6gWkA2xlh1b2rgNJsJ9U1O1sbRC89xII0
    UDJJJr6ptvBwntrTwXZuFj0+1+0X8n8O7GcGgD528X63Jql4jKNlvC+FX1ptnMseoSDH+tUMM07xfDBBc3d
    tEQGt52Vdo4YA4zVSUGS3guY/vqPyoA6BHB67VWpFfcpBbj0rJtrrzwCwIcDkY4/OrMk6RwknGO+3k/lQBJ
    JPs354Ve9el/CKw8rwF4g1aUfLKxVG9eK8strWbWZo7e2jfyWIyAMl6+jtU05fDvwOijNq9mGflX+859TQB
    8wkbPElyDwpJY0+3uY9Pka5zzcRvg+nTFU9auiup3Drw7jHFUrtJmihZ8BMYUZoAeZmksgu4szPyTX0l8IL
    JNQ8BXeiSBGdoGYZ9cV82T2slqsIuBjcdwwc8V9HfA67SPxBpoUHyhFtdcZOMd6APGFjaGea1cFZYHKFT7G
    rkJ2EZP4V6L8d/A0uneIrnV9JsJoLeRtxfBKNnrivKoL8bQJg8bLxtA3fpQBsqys3BA+tZWtXASyeIcs52g
    Uv22PynYbt3ow2VQjWS7uVmkGUX7vHAoAp6pEY2s4h3ABFej/Dq2mNnNFqCGXTXPls/XYTxXn2qnfdRTrkR
    R8Z969y/Zmu9O1rT/ABB4Q1HAub0GS3c9jjP9KAPDfHfhy58MeIJ7O4TEbHzIW7Mh6EVztfTfj/wbL4o8GX
    tvMBJ4m8OBh8nJmiHOB+Ga+ZSMHB60AJRRRQAUUUUAFa3hP/katG/6/Yf/AEMVk1reE/8AkatG/wCv2H/0M
    UAWviH/AMj/AOJv+wnc/wDo1q5+ug+If/I/+Jv+wnc/
    +jWrn6ACiitDQNPk1XWrGwhUtJcTLGAPc0AfcnwQ02y8B/Aq31RhteW0bU7hm/iYrkD8gAK+W9RvrnVvEU1
    5dtvu7l2u5yP77nIH619R/tB3cegfC600azKxJcyxWaqOP3SDJ/8AQR+dfLeiQGe7kuM4MkxCn/ZXp/KgDt
    9EPk24EikEDk47nr/Otp76FrdkyOnHNZUcN4IFAQcjO6qd3pqOjYd/M7sD3oAms55ba4aWNC6Z5966zT7r7
    Zbl502qBn3rmdMiktnjWaJmQd+1bd1fwwW5K7Vz/D3NADJrjzpzbWq8vxn+6Ku21tHYhIYEMlw/AXqSayNH
    fErvCN08zhUAHUmvVPDmgRaaiz3P7y8Zcs5/h9hQBDpHh0vDHJqh5HIQHAH1qHxP410/QI/Jt2R5VGAi84r
    nvid4xlsSunac+2Uj5mHavLPInunMkhZ3bkk0AdFrHxE1e+kbyXWJewAqbwtDqmsXQmvryVIAc9cE1zdtYZ
    uU3jqelenabbDMMdupXKAE44AoAfdXn2H5bNXnfpkkkVm3Xi7XbMFxZARj1Un+tdZBYxKNoGcdzUF/Yr5bE
    DA/OgDD0X4swicQ6zbtEp43qOn1ya9Q0nU7TU7RLmwuEmiYcFWzXz74wsLQykMmyU9HAwDVz4MarLpvikad
    NN/o1wMKpPG72oA9s8SaNb6vYyRugEvVWHBzXmB1P7KzWR2pJGxjbd6ivZVI
    5yR7814L8RBat40uY7ebYzjcSvIzQBr6Ysc9w7ytlgelakxRR8i/jXDaHdS21/smY7iOh7j1rp57uKRMLMo
    3deegoAgvrrJ2oRk8cVY0NTHZukysrseMijT0sWQyNIgCn5fmqaXVbaEffRse+KAFvW/cxrj5ielef+M7BL
    XVklUfu5OD9DXW3WrQeZHhlMjN0U5rL8b2rS6dBKQc/wBaAK3wW1ZvDXxI0n58QXUrabOD3DcofzxWH+1b4
    c/sfx/JdxoRBd/vFPrkAn9c1DMzWN5BqEfEkLQ3a/7yMp/pXp37Y1ot54O8Pa0qj5mCFh0+Zdw/rQB8j0UU
    UAFFFFABRRW14N0KfxJ4m0/SrZWZriVVOB0XPJoA95/Z38GW2ieFbn4ha3AZJVLJp0RHU9N+Pr/Ku+1u5bw
    z8HvEWvzkpqWslgH7gNwBXe63ptppug2Gg2yAR2kCoiKMDOPSvHv2mdT+xeA9I0QMPmcO+D70AfMkc8k7xe
    apf5izZ7g11K6O1sYJsebYTkDA/gNcu6s6s0TcAAYFej+Gbq3n8HyQXbKhQfKWoA7W1+Etgl/pcFxdOg1JN
    0UgYbQfT612Dfs7aVZlpLvULudVGSowAfyFeVWOtyrokMNrqIlNs+5IZG5X3U9q+lfhP46tPE2mCy1C5zdh
    ApWRsE/40Acl8JvA3leJpLqW0WG1sz+5BXIfH1rS/ammZPh5bzRqxBmAIHbivZY0t7CzYpsCIpOc4zxXj3x
    0c6r8H7mXyxGVm+UAg5HrQB8b6xAs+qWqgf6xRnFSeIIBBEqKAApGM96LpWOoWbjOVGCa1PEsIfTGOAW4Oa
    AKuvKBaaTMQMkAZPrxXsXwclkPxg0uC2I8rygX44xtrxHVbjzNBsBg7omHP4V7N+zXL9o+IlrOwy3lbc56c
    UAfUfxB0z+3PC93p8MfmGQgcDJU5ryHw38JtKv4prDX7UPfwnMbKShI98V7F4e1O2S9v7OS4BlWVm/eOM4r
    Gm8VaPaa1qOoSTKtpbR4kmzhS3oPXoaAPKPG/wAN/B/h02tnbx51C4I3Q+YWKj157V518SNG0dby30/w4Sy
    ov+kyKeAfTiqXxE+If/CQ+LLy9sW8uJiVix/dzwSa5XT/ABY1rOUkjD5zk7etAGZfXVpb6i9mY90CLhPr61
    r/AAe1ZdD+JOl3LuFSSQLuzjrkf1rmNQ8u4vZLl/3aMchfWqgkNrc28sTDdHIGBHbmgD7h1TQ4tP8AG1r4j
    sfMzMwW5h6rIjcE/ka+aP2mfAsHg3x15+nKy6dqim5RccIxPzKPbvX1J4J1Ma/4N028EiyMsQVj7is749eF
    U8Z/C2Z4oVN/YDzY2xyMdQKAPg2inOpRirDDA4IptABRRRQAVreE/wDkatG/6/Yf/QxWTWt4T/5GrRv+v2H
    /ANDFAFr4h/8AI/8Aib/sJ3P/AKNaufroPiH/AMj/AOJv+wnc/wDo1q5+gArvfgTbC7+LfhmIgFTdqTn0rg
    q9M/ZvG74z+Gwf+ezH8kJoA+gP2trg/wDFM238I+0Sn6hVA/rXz74cmaBbJhyrBj+te9ftZq0mqeG0UZ/cX
    J/Ra8M8K2v22ytkUc+Wf50Ael2mr23kgSMFIUDBq3azWlwrFTGwPXAwa5qPw3IUXNw44HAofQLyE5hnZgOd
    vegDpYmjErRZDKegNM1CyW6tMqPnQ8GmWlirQKx3iTH3s8g0+za4ikkWYgnP4MPWgB/gcRR6vZefjKSdD61
    7DI25WUcE55rxN0kguftEQON24gdq7bSPFpaNVn2uQMZ6GgDzzxzp09r4gaa4zIrnj86db7VjAEYUnrXfa3
    f6XqmUljJf3rHFhA4AVMAd6AOestOee8AQZwC1dB4b1CeV/JnKrscrnHOK3dB02NJiUIVipO6uc1Em31CRr
    cHO45I6ZoA7QHng4qjql75MZVsZI6VmWl9d3MCrtHmDjIFaVvoRm/eXUjEnsKAOI1W1Oq6fPhf3sRyDXMya
    Rd2EsN6krRTRESI3pivY10dbSOQ253K3JVh1qjqVrb6pbvZ3URR2BAI45oAwE+IWo3GnbJJoPOxt3qME/Wv
    PtZ1BJb7zldpJScs57mota0W50XUmiuo3EWfkbswqC2tRd6jBbRNgOcEntQBoW159p2LPJsZfusOtXtDv1k
    1I6dN8obq5/pW7c+DrW1lg2lmDLg5PU461xHiOzuNPumurYOZLVgc46rQB6jH4ftY41MRYY55Y80h0+OWOR
    GSNsdyKyfCGvtrMUYkIUKvPvXQ2wf7VMucKV4oA5DT9IEV6JXPy7uMmtDxdItxbpBCfutubHpip7uNltinK
    sHyCKoWEL4vIrtt07rlT7UAcrPGLhY4Sck28q/kCRXpHxmuDrf7LPh/UHO545LfLf7u+M/yFcJpMAGuwpJ/
    tqc+6muq8UzC4/Y+jQnBt77yx74uW/oaAPlmiiigAooooAK+gv2OdBF/42v8AVJVBjsoAAT/eJ/8ArV8+19
    n/ALKGgnSPhfe6q/E2ozEqf9kcUAeh65Kkl2ZHcB2fIOecCvkX48+KDrnjGW23Zt7UbB9a9x+KfidNF0u9Y
    yFJghSPPcmvlT7akn2uW9TzZpmL7zzigCjayGMucjnpW9pGmX2pwiJpvJg64Xqar6LoL3SC7nykJPC92rrL
    dRYuqR5EbccUAc1qvhy402Fri3uHfnDLjBqTwn4r1LRdShl2u4jYY5wa7Q7JYzGR1HOa4TxXAun6lHlBscc
    j1oA+j2+KV3faGI42aOKZMMWx8pxXNeL/AIgWs/gCXRJi8kxOVYHj+deS+HtUkltmtMkkPlOf4ao+IYmTUZ
    Idx2lcigCnaSM5AlJyG4rQ8RSMdLXYTgYzWXbgm28z/nmeafqV359tsjHDCgCqJGuoI4QG2+3rXc/DLxGfC
    eri6/iAwM1w2lS7GRCRjOTUt05dppF4UHAoA9sufHE93cXN7aSbbhwd7E9RXnXjPxjfajaJYiWSO0V8sFGA
    x/rUll/oeirescgL9w/xGuUuL2fWJwqxooB3AAUAWdJhS+mjhJ2xE5OD8x/Gu1Xw3p6RcxllIx80hriNCjn
    g8RQIwyScHI7V6XLMDI8Zbao7UAeX65afYr5oVLGBTlAecD61SmiIwVIIYcivR/EempqVgxUYljBKMO/sa8
    4ETiRkBBK9jQB9M/s0eLmuNEm0WVlLxHKrgZr6J0Pbd2VxaTgMkqEMPrxXwP8AD/U7vw34tsJ2RkV5FzjoR
    X3H4QvvOvIHU5jmjDD8RQB8GfE/RjoPjvWNPKlRFO2AfQ81y1e5ftdaObD4mNeKpEd5Cr59TzmvDaACiiig
    ArW8J/8AI1aN/wBfsP8A6GKya1vCf/I1aN/1+w/+higC18Q/+R/8Tf8AYTuf/RrVz9dB8Q/
    +R/8AE3/YTuf/AEa1c/QAV6T+zk+z40+GPRp2X/yG1ebV3fwLuls/i54WmkOEW8UH8QRQB9QftE2pvPGHhC
    3Az58dzEM9yVFfPXgmQWkstrJ8s0EjxkH2Jr6Y/aGheHUfA2qxj/j21QRufQOB/hXzh44sJPDnxQ1SGUbIb
    idpEPb5jn+tAHamS8m2+RwuBzRHeXsD/vcFc9aTQr1W09SzgsvBNXrKFpi7y42noDQA2HUXeTCqA/p2NXN2
    75iNp9qlihtgpUpj3AoaMo/y8r6igBnmqgG8DnqasKlsw3BBuPccUgSKVQsi/iKnjghXAUn86AMPVC1ncLt
    Py43A+la+lXq3NujjjI5zVXWrZS8UjEkZxzWTPenTHmg/h6qe2KAOztb+IRTRq48xR2NZWC5CkZLHg1y/he
    y1bVb+S9ixDZKTumc4Uj2q7rviO109mitD57r909vrQB2j3lvpFvArgGSWtqz1GCaFSrAEjpXiR8R3eq6lD
    vGFToort9Ogu3KyNNsUjtQB2Ul7tcgnio51W5iLJjeOQawVuvlYBydhwSaQahLAxI+YDrigDnvildzTaJBH
    5I3xyfO2OR6VneANEI3XN7HkuMxt6V1erNBrNmV2jzl5IP8AEKm0qBbe0WJQQAPl9qALSFjGiSDLRtwT3rM
    vrCK6trhQoJlbacitWQfdYA+hpI42OxFUtKxwqgZJPpjuaAPJrdJvCfiAo+fsrNn6V6NFdpLCLqFgysM8Gs
    vUvDt14o162t9NjaaXYQ4UZ49/T6mtvTtM0H4essHiK+/tjVC2I9NtT+6h9PNk9fYfkRQBo6Fod54ghZ4oV
    itV5kupjsjT8f8ACuZ1m3+zXUjxOsnlMUEiHIYA9R7GtvXvEuo6q8SXDLDZrxFawrsiQdsAdfxqpPHHPBvJ
    wFB3D1GKAOE0yTz/ABLcuMFYt7fkprptdjEP7Hcsko5nvvMjz3zdY/oa5XR0+xQ+Ib12GyKCQqT6sMD+ddR
    8bo38O/s0+DtEmIE9xOkrLnth5D+rigD5dooooAKKKKACv0B+FUKad8FtEVgAnkhznjrzX5/V91NcC2+Aeg
    gOQJ7WPJXg4IzxQB88ftAa01/4gjgQv5K9ATxXm1ivm7VZPl3DPvW948lil8RBJWcwRLwSeTVHQLdp13Ku2
    Ldlc0AdtDiKxiESj7oGMdKjeMTqrcgr+FKrNsT5shRjIpm/94MDA9KAJASjLyCx7mud8d2sk9zavEhJAweK
    6BVJcOxIxVtoY7gfvQCnvQB5u8FxaywXSfLtYFtvGK6fxHbLqel2+q2Q+aPhwO/1qx4kt4bXTpAqqc9AOtY
    nhS83vLptw5SNxwpPf3oAythjJO3HmdV6Ctyx0YSQM5VSdv5Vg6s0tvdPAcNErYBHarGlapdQ7gV4A4560A
    Jc6P8AZ2y0mMnjHU1Z0TR21bWLayjysZbL8c1j311ez3Jkc4LdFHauq8KatBoVnLeyvuvV4UGgC98Sp7XT4
    /7Nt2UuoCgKelcv4djSLDMCGNRZm1nX2mm3SGQ7iSO1bVtpjyavEApWJO1AGpFaMt1BOqjfnnNaVxuS7JcZ
    LdMVakh2uuzt0qpKGecEj5s8mgCWaUJC24kZ4xWRdeHLW5t2Kp5TsMg9Oa1XAkkKshwvQmrFuiyRE5JK/lQ
    B5l9tubScQzuXNs4IDegNfUvws8efarzRopY40hkQIJEkzz7jtXzb4z077PfLeqpMUnDj0rQ+GWpvaanFtk
    YCFw4PbFAHt/7aumlrfQ9SXG0bkP6Y/nXyjX2N+07JDrfwa0rU7Z1kRZUy3vjn+VfHNABRRRQAVreE/wDka
    tG/6/Yf/QxWTWt4T/5GrRv+v2H/ANDFAFr4h/8AI/8Aib/sJ3P/AKNaufroPiH/AMj/AOJv+wnc/wDo1q5+
    gArS8Oai2j6/p2op961uEm/75YGs2igD9CvixCnif4QzajajLLBHqEBHUEAN/Imvnn4kyW3i/RtNu0ITU/I
    Ulu7MoGf5V9E/B51174HaHG5Dedpxtm79AU/pXzp4h8D6t4ajttXuw39mrcGENnhckigDjPDOvpb25jvPln
    RtrDs2O9dtH4ygRUXyht9a848R6bbfbpp1uArNJxEvU+9WtPtfOtP4sgd6APWLHWLO8G5JApPYmtKJwzZRs
    rjtzXgyLcQ3OIZmUZ9eldXZanPZouy7yvUlmoA9VEanDVZtoFaQHOPxrzWLx3HAu2R/NcdgeKwtc+ItzGGN
    kpjk9ScigD2rxLbRRaUZpHjAXn7wB/KvK7q4S8uc3MjLb9SQeWFeWXXijU76/S4vLqWQA/dLHGK9Rs9JttQ
    0CO7t5vLbjcpPGD3FAF7VPF89/BFp1pGLbTYVxtj4L49cVzs7bgW9ema9s8KfDPQ55ILaefiSIuZXOMnsBX
    m3xF8Pf2DqEkUQxGHK5+nQ0AZXg1w/iGyhkTMbkgnHevUruRoX2ggLyOK8y8EzxR6lb7sbw3HNegXsoZDg8
    5oAgkmInQbsK3DAd6aZNpfMnHYVRZz0P3gelMlPTjv60AWZLnayPASJF/Wtuw1FJvKQtsL9PrXNIeTxnP6V
    R1cO2j3TROVkhYOjDgg0AekwxPJLHHFG7yO2AqjJY16x4K8IxaOBe3gEmouO/IhB7D39T+H18c+HHjCWXRI
    ru1jhGpKgjeWRdzLxglQeOfoa0tT1bVdSyt7fXEqHqpfCn/gIwP0oA6nxxfnR7z7FoMlnbWdxmSf7JjzGcn
    kORyPbp6V4x4nhVdRSYAFJeG46H1rqwDHGcdTwO+K5jxNtZo0JJOfSgCCyvrgFEuHDhRwTT7vVgts6bz5rj
    J9hVGSJba1eScMUAyKwNCC41HUb9iViUsoY9B2oA3PCtjJ4j8TaT4atxuW8uFuL4josKHJB+uKrftgeIUvv
    HNlodo3+i6TbBCg6B25P6YFew/s+eH4/D3g/U/G2sqEuL+Np0LjBjt1BI/PGfyr468Za1L4i8Varq07Fnu7
    h5eT2J4H5YoAxqKKKACiiigAr7b1dls/hX4Ls2AISzQsPTCCvieEEyoFGSWGBX058R5W0zS9C1KSe5S4Glp
    G8DE+WTsHIGev4UAfPvia4a+1+9YMArSbQAK6rRohBp4UAHC9a5HTiJr3fJj5nL4PWuqiuIhaNsPQ44NAGl
    ZSE9s561LOTuG3Ix2FZujzy7ymDtJzyKuud0p+Y0ATW0U0hLAnHoTV6FdseHO41FZyMmQwA96mBQqzE8+go
    Ac9tDMoMsSsB0zzXLeL9OtoVgvbRFjcNhwgwDXWxpggg/KR0rP1+2a5svs6qNx5Bx0oA4Q5nkdUQqgGcgZq
    bwxaWst5PFeHaApKk8HNPvLxLW3VbUst5GdrrjII9ax5Jb3zBLJjL88DFAF+CARXlxI5yedoxkVlqZrq/ER
    XJkbAFWrW8uEfy3jYRseSFySK6TT4rGSaOe2KmROuOcUAdNpum29jbxxoiiUAF37sas/KHPyjJ7+lWrdfNh
    DRkZI5PeqEgK8r1B5J70ATMwIG44UelZtyxDEgnHp61dlk2oAMfN6Vn3auu1yfkJ5oAmSZHjwBhwOlMEzxs
    DkfSn2NjNeXCRWcTyTyHbHHGpZmPoAOtdD4k8E6j4Z0m1uNans4b25fAsfMDTomCd7KOAOMde/1oA5rVIkv
    rGWEjG9Dj61wWgXkulawerqMowPpXo9rGu1cngHkGvP8AXoVs/E7Mi5RjnHY0AfQPiqWG+/ZgdbWUSmG43s
    AeV9q+WK+kfhboP9s/DHxbteVvMhbbGT8qHaecV84OpRircEHBoAbRRRQAVreE/wDkatG/6/Yf/QxWTWt4T
    /5GrRv+v2H/ANDFAFr4h/8AI/8Aib/sJ3P/AKNaufroPiH/AMj/AOJv+wnc/wDo1q5+gAoore8D6HL4j8U6
    dpkKFzPKqsB6ZoA+4f2Z9PvdO+EulR3wKq+6SFT1Ck/4039oGSwTwBNpWF865lUxxr2IbJNdbqGvaN4N0WK
    0mnUfZYVjjiH3mwOBXzz4z8SS+J9TM2EihByFUcD2oA8o1PSm06/V7hGZMKd34VtMbObT1aLzMjrsHWtbU9
    YhNyIbq0S4icbQRwQarxKkcey0tTbnPUHORQBz0+n75s/ZZEi253EGs27sxsJDHyume4rvGJuYGil1RomHG
    xlwDRe6NYPaRpDdQ3EijJw4HNAHnkdrFEu5VLDpk1bvdHtZ9LeWUtEyjIkxwfavQtLj0NrEwXNnNHP08wrl
    c+tZvjS2gg8PM1rIrxqfmHrQB5DY6bG0/wC8kDqD0Heu80C7kdW07cFhkGFBPT6Vy2nIi7m/ECr6yMkiMvy
    sCMUAe+
    +B/CV019ZXOqarPJbQDcsROAB2zWn8UNEh1VJpbWQSCRcq3oR2q94EjN54RR55C0vlAE+tZMV6UnmgmcCFW
    wufWgDxXRv9FvZGk4mhfH05r0SGUzxZBzuGc1xvjCybSfFNwGGEkO8e+e9bGg35aIJkZTqKAL0shWUZH4ml
    dwWycc02+znf2PSq6sXUegoAnDjBxVeUGSxu0AJ3LjFQmQhiBW1ZRpHamSUDBwOe9AEfhGzewt7cICoC/N7
    11rSF1+U/MKz7aRCBtwBjAFKJdlwNx4agC0k3JDAA/wA6xp8XOoEgAqtXrqRY0aXdwoyTWdYsBB5px+8OT9
    KAKXih1TS37H1ritKtZ/EWraT4YsiRLql0olI6rGDlj+QzWr491Rbe32MwBPNdn+yV4Yl1LxJqPi29jIitU
    Nrak9N7Y3EfRePxoA9A/aY1uDwh8HjpNjmJrwJYwqvGEA+b9B+tfC9e7ftbeMX1zx6dFhYfY9KHl8d5D94/
    h0rwmgAooooAKKKKAOw+E3h2TxN480uwRQY/M3yE9Ao55r2b9o7XYnuzpk9j9nazQRQuOkgx1FeMeFbm50z
    w1quo6fM0N0rpH5inDAZ7fnWz4912fxJo2h3VxNvureLy3LclsdzQBxdosrX8ccQ/eNwc9hXoNnplvbWyqU
    ySMsx9a5nwVZebdS3Uv3hwpNdfK3y7XOE9R3oAZO8aIqxAA4/hqK3VZFdej4yKsxRxZAADZ6Y7VDGFhEsmO
    F4oALe5ea2LPGY2RtvPereCVxgqD3qKNg4QnoeakEglZju4XgUAPSVkQojFvUmqOqSXs4W106JpbuT5VVOc
    e9SzyCBGdse2O9db4FthbQS6jMQsrjCk8cUAcL/wgGsx2hlkgAmC5MfmqWJ+ua5Fkit7+S31yKWNT8oOMFC
    O9fQzTq/7wdW9BmuU8UeF4NbvY57iQnZ6DB/OgDz/AEHw/LrtwyabIy2MfAlmGcn2xzW3qfgTUNIU3ttcx3
    Eaj96igg/XmvQtKtI7BUjt4kRFGAQOKs3hYRyZO4OMMDQB57aTs1tGyuQOh9afcM0wwrFGHRqq3UL2F7Ih5
    iY5Ar0T4VfD668bXnnTeZb6RCw8+fu/
    +wnq3v2/IEA89SO7jhjllWTymYqshQ7XIxkA98ZH5iu58PfD671Gx/tPXLiPRNA4Ju7zgv7Rp1Ynt2PbPSv
    o7xVpeiaR4VjSK00eJtNjZ9OS+wIlkCnHUjJP164J5r5X8Sa/qviS7+2avfPcT9FVjhYx6Ko4UfSgDpj430
    vwzE+mfD+xa2dlKSaxeANdTeuwHiNf84BGa4K/u5ru5kkuJJJ7l23O7sWZj6knrUN0iygJvAdecimJLJGAp
    AJPRvWgAgW7DEzlNmeAvauJ8WG4j1ndcqMFfkx3rv0ZVUh8VxfjtvMmilUcLxQBb8JePtW8MRGHTrySOOT5
    XhxlW+tYnjGyig1AXVqNsF1+82f3GPUfSs2S0naD7WqNs6k+lMvL+4vFRbh9wToMYoAqUUUUAFa3hP8A5Gr
    Rv+v2H/0MVk1reE/
    +Rq0b/r9h/wDQxQBa+If/ACP/AIm/7Cdz/wCjWrn66D4h/wDI/wDib/sJ3P8A6NaufoAK+gP2YPDjrPd+JJ
    7d2jt+Inxxkd814t4V0l9c160sIwT5rjOPSvsvXfEGh/C/wPZ6SR5t1LECttDwCcYyx9KAOF8Y6jd614huJ
    rgMUjO0cHrWZ5KMm0AYA57VQsPFlzqbyLIYYi/KDbz9M1FPqE0cjB8hhQA69ggQBtillOcGteztre6txLaS
    RgsOUZxwa5We7aVjuJz61SbThcMXinlhY9djkA0AdZqWkGVQz2bSgd0OQfyrNOnw4/dae0Mg/iBP8s1StLP
    VLMg2WsXCf7LOSp/DNXHv9dUYe4tm99vNAF+0imZBCzyqv8RKjGPyrL123sIbJ4bi6abJyqoeB/vVG9xq8y
    t5l6iqeuCRXLa9DJBlzKXLHqp4oA6DRtOgk8uKLyZLiU/ukRCxP1q3qWjT20nk32njbnqqkEVwqeJJtBs2f
    T5GS+cbVlB5Qe3pXpXw31m51nQUe8vjeTjIkEnzMv1z1oA7aHxRp3h/RIILNSx2iNhuGVrm1u1udbiDTI0T
    NuVfMHetmXS7C7gK3FrCTjqqgGuZvfACTRSXOnXXluhyI2bn8DQB2/xO8KLrXheLU7CPN9ZR/OByZErwW11
    WbT7tJ0BYLw6+orvtD8a634Sm+yat5lzYsdnzMSQPxrC8fabbC7j1HT1VbK8G5QvRW7igDooL2K/s45Y
    sFHHHtUDLtDYzxXH+H9Q+yxPA7lQpyK7zS2S8t45FOQ3GaAGWFo0j+Yy8CrHiqUWel26KQGLbuuK17aERcc
    niuc+I8BktoSpOEFAG1pt3HLaxHpvQHntUks0caZaVfqTXHaJfBbSNHYjC45NGrXiC3bDE8cUAXtX1+KZ/s
    cLZJPzMDxVm81S3stO3O6gqnTNeYS3y2sxfOZTyF9PrWloWkXniTMt27x2oPGT9/wD+tQBWiivPF+vwwwo8
    sfmBFAH32J4Ar7R023sPhV8Ky03lqun2xlmIOPNmI5/NuB7V5v8As9+DYZNRbWxEq6fYlobUFf8AWS8bpPw
    HGfesn9snxisGlWXhi0l/eTMJrgKegHQH+dAHyv4i1WbXNdv9Tujma7neZvqxzWdRRQAUUUUAFFFFAF631O
    4t9MuLGIgQzsGfjk4q1M050iIsCI+TmrPgbw3P4o1+3sIAdrsN7dlHvXq/x28G2nhHTdM0yyUFvK3yS54c4
    oA8/wDCF3FFYlZHUNnpnk10kbPcMNyYjHTNcB4VaGO/3TYyDgA16MJYVVSp5b9KAFmQqg8kcdyKh8sKm1xk
    Hr6VJd3McNsCTw3YVkX+sNDA3lwMxX3/AJ0AacQLH5RhV6Cku5Rax+bwqj71JYzLNZQzDkMMttPANU9Vnjn
    YWueZTgEGgC7p9q2qXkLAFoyQcCu5uQyQJFHhIl7VS8LaK2m2CFzuf19K0dTCqVyV3dcZoAWBykQbl+OPap
    xt+V0ILH7w9KhglQ2wOORT5GEwDxxsCBzgYzQAKWlUxK2MnrU0pCbVADY6g9aqxsUXeqkDPfrUjB5WLnO8j
    AIFAGP4l09btEkjiLKMZHTNTS/FHxHDBHpNndRaPp8C7EgsI/LCj/eOXz77uevWtAB/limyx7dq8/8AHlt9
    jjN4EIQNzigCfUry61G4FwZ5riU/eeZy7H8TTA5xhh9TVbRbxLm1RkwAR361clljjQmRTj60AR2IVmlG3j1
    NPn2K67WXB/hNQ27tksuVU9AaUDzHJYYK+tAEtxIgiPmMqgDoa4fxLew3SLFbkSYPO3tXY37rJbCJgGyO4r
    gfKSC+uo2UAEErigD234X6FpGp/Cm+l1RYlbeUWUj7vFeH+MNCm8Pa3NZSg7PvRt2ZexFe0+CYvM+AuoANi
    eS92D8h/jXG/HueEa1pNigUz2tkglYep/8A1UAeW0UUUAFa3hP/AJGrRv8Ar9h/9DFZNa3hP/katG/6/Yf/
    AEMUAWviH/yP/ib/ALCdz/6NaufroPiH/wAj/wCJv+wnc/8Ao1q5+gD1f9nKG1k8bM93j93HuX39aX4u6je
    XXjC4uLkMIs4iXsFrz/wprs/h3WYb+25K8Mv95T1FdRrniyx1eSNpVYoDnaw5H40AQWV/PLs2pyvQqK6KzX
    Vr90WG2kkIHUjAAq9oWpJBZxtZWsEkYGcFQT/Kma746v1R4lVbaNRztG2gDVtdDulhMl40UYxyA2SKbH5Ik
    8uBZJHHohNcnpmvtOI5JpD97ceeorttNk1iLRH1q61S00XSXfEbSIDJIP8AZB60ASJpN/OhZ4XgjHdhj+dV
    ZLRonx5p3D+9io7Lxr4NnumTWtU1q4GD+9VSBu7fLu6V0ehR/DrxDpIL+MDYaicgi6QLk9sc0Ac4TtPzlpC
    P9nArl/E9yuxg2MDtXeXPhOOF/wDQPGmlXRJwF8wdPzrXtvDuhQpHHql5Z6m5GSIwFwfqKAPmK7mM0xJ6Dg
    Cr3hzW7nQ9RjubZ2AB+dAeGHpXv3iHwZoIHm2NtCEPVDz+teceIfh7uhludIDqy8+SeQfoaAOx8NfFPTtTl
    S1vbc2krcB88E127SK8BaNuGB+YGvk6WOSCVkkVkkU4IIwQa9D8A+P7nTxHpmo4ltXOFlY8x/40Ae6eEvB0
    HivTLmO9nWGYFhGWGckZ4rndc+HXiDS7S3sHiW6sbuX/AEd4skq/p+lbHhfxLBpjW8srboZJuNp+8e34V6/
    aeItMTwwzQ3KPeQSibyc5KHOePbFAHyT448L3vh7UYEuVaMSLnJXr6itTwVqieSbV2wQcpmvUfjtr+k+JdL
    hNrG63cPzEsOD9K8D0GNrjU7dI8gl+3bmgD2i1nL43gZHUis/xbcQx6NcNJjO3C5qS3/0aP524A5rhvHmrf
    a9lrCcqDl8dqAMuDUFSNecECsvUr651CT7NZHEh+8w5Cj/GtTSPDV3qK4WNxGRk4HJFer/Dn4WS3+p28dxb
    yQWQG532YyPrQBxHw6+GM2uLNcyhorC3G65vJOnrhfU11Vvp632tafoGi5D3kn2dXAz5cf8AE5/DmvQPitr
    1jY6cmg6NKkNnarsYR8B3/rirf7OPht/s134pvVPmXf7i1Vl5WMHlh9TgfhQB6mE0/wAHeEiIUEVhp1vwO5
    Cjv7mvzr+IniW58V+LtR1W7csZZWKjsFzwBX1v+114sGjeBIdJtpSt5qEoyFOCIx1z+OPyr4joAKKKKACii
    igAooooA9Y+CF0bey8Q/Ziq3ohV427gBucV2vx91H+0PAfhG7zvd0KSyHqSOua8Y+HmtnQ/EkErHEEoMUo9
    jXp3xOnEvw/t7aJi8UE7SR8ZwD/
    +ugDxYxuLwiEkEHgiuws9NvJrZJJJ5MjnArl9HVptWgA+bJGT6V6hEoWIJ90AeuM0AcpaeeNRZLgsyj7ue1
    azWa3CMj5AfhsVblgjE6z8H2FSfK2QhyTQBnpafZ4Bb2RIUe/Sq39kSpqlrdtN5gjYEr6VoxuouipGSvetG
    2+YHf17CgD0ZLhJoI2iAw6jp2rMu7d5JCxOX7EdqTw3cQzWoQv+8X9K0LtfmIQDBHJXigDNtixRoyrKw/ix
    1oMxSZRvbd6Dt9abcK6ph5JMZ4ANPtY1B4Qj+ZoAnMm5STjcaasjq67Onc1IQC2CuGPb0p8qoAh2+xxQBAU
    zukZ2Yj86xPF6Q3GnxoyDAOSDW3OVVto69ciuU16YzXRxz2AFAHMzh4JYhFGNp4yOMCpZYQpVy7vjnk1Znh
    JcN8xx1FDqxYHoMUATqPkEhHJHQdaiLkI5TkgcA0QyZRgAdy+lORkkBK5BHXigBlrFJNGWucCQ8ADoK8+8S
    Nt1aVVONoxxXpL/ACggfxKcD3ry/Uona6unlGHEmMGgD3P4aXJj+G1pFcxp9mFyZTu/i6V4n4w1R9Z8Tajf
    SNu82Vtv+6DgfpXr+h6beS+ANNs7WNt9znaB1PbivGvEWkT6HqstjdjEqdQetAGZRRRQAVreE/8AkatG/wC
    v2H/0MVk1reE/+Rq0b/r9h/8AQxQBa+If/I/
    +Jv8AsJ3P/o1q5+ug+If/ACP/AIm/7Cdz/wCjWrn6AClpKvaLaNfataWqjJllVcfjQB7t4V8IXGn+F9K1mQ
    ny2CF0I6g1538U5EGu3sVvjyi4K49K+jPF+rxWOi23h2Hb5dnCu/jknA4r5y1GzbWNauWIIcvwtAGT4f0+S
    43PK4RAMsScBVFU/FWv3OtXMaSSMbW2XyoY88BRWx4zSLSrG2sYJt1xKN0yqfujsDXJwW5cjcDz0AoArgE9
    BSlGHUV1mleG57pAzDyo/UjrWw3hCJQP3hY/SgDz1JZI2BR2Uj0Nadn4h1G1PyXDkehNdBdeF9mdgBrBvNF
    liJ2qc+lAHWeHviTcWjCLUIvNg74PIr1fQ9d07VbRGsJowXGSp/lXzNLG0bbXBBrR0HVZtLvY5I2OzI3AUA
    ekfF/w5EYRq1qoV8gSADGa8lRirqw6g5r27xD4gs73whMkvzsUBGeOa8QYgsSBgUAezT3E58P6Jf2seQ8Qf
    GONw/8A1VcttevrzVLWVy8RK/vNpwGpfh7qcd98OVt3VGl06UMueu3PP863ZLJNV1dzCIxsQOoTigCDxxfa
    XZ6FAkkErXzgnP8AD+NcJ4EIbWg7DpyBXVfEe2SCxs/tAkN0x2jP3cVyXhH93qpoA6fxTqj20WI2K7zjIrk
    dMZdU1cxM37qAbmz/ABn3rT8XMWjhPuTXT/Dzw3psiwXd9cohl+dl6ZHoaAPbvhdFpth4Xiu7rTka4ZRtlk
    wAw/wr0WWWZfDl3dO4SWRODEMhF6fLj/Oa87s7KDW5LG0M5S33KqBGwNo7Cui+J3ie18JeG/sNtjzmTaFJz
    tFAHicmjSeNfiNb6HAWSzQ/vyOoj6t+PWvqWytbXSdMitrZFgtLWMKqjoqqK8R/ZnsRfz674huOZnlEEZ9B
    jJ/pXW/tDeLv+ER+Gmoywti9vVNrB7Fhhj+Az+YoA+Pvjx44fxv47vLmPK2Fuxht1J/hBxn8a84pWJZizHJ
    JyTSUAFFFFABRRRQAUUUUASQRySzIkILSMcKF65r2vTILm+8Falp93EzXEMAkyR0wOa8i8O366XrdneSAlI
    pAzY6474r6e+F+r6N438ca9Fo0Uq2Dacc+d99n24PH1zQB8zaNutrkTLyUbBFd/YzS3SLI0bKmOCe9cJfKL
    XUr6I5Ro5G46dDjFdj4U1NbzTXhcgSx8hfagC/dM6ooBVWz2qOJJI5TuPBGc0rvvjbd8vPFWC4aFGzllGDj
    pQBDZxqjvIcHPdulWowS+R36YqtGAXJIBBqTzCjBQPxoA0tPke2uFeJj15Fdcl2ssG6Nxg9a4qFs5A4H61Y
    Z5I4du47fUUAdckaSMHcj5emD1pzv5UuFiZg3pXm+seI9U0wxiwWF4z1Lrk1CvxFvkjBcW/mDggQkc0Aemx
    tLLuG0Kw6ZrOvtZS3cRFCzr1IrzP8A4TPWrvzFincPJwBECuPpmrehW8kcjSXszz3L9dxzQB1c2svMWMKHB
    4zWTI2WfeSZDz9KkYsFKxfKB0x2qtAWJcSdR1PrQArSh4yABgd/Wonf5FxjB6mpHVZnG3AAGMGq6ocnIyAe
    lAFJrgtIwh3YHeqsKXVrd/aPOaRG6x9hWmQhYheAPamSuUUFe3YigC/BKJBGYznJ5Y9q8/8AEpX+1bgxvuG
    8Z+tdzp8Zh3SAkRuCcelcVp1h/bXikWKOB50wG715oA9l8Za9deB/DHw41K0hHmrC8hjP3XxgjP514f4s1+
    78T6/d6tqGwXFw5Yqgwq89BXr37VTpZar4a0GI5j0/T1yPc8f0rwmgAooooAK1vCf/ACNWjf8AX7D/AOhis
    mtbwn/yNWjf9fsP/oYoAtfEP/kf/E3/AGE7n/0a1c/XQfEP/kf/ABN/2E7n/wBGtXP0AFbvgnUotJ8SWd5O
    oZI2zz0BrCooA+gL7VrnVL671FhlnG8sPu8dPwrya98Wah/a8tyjRrKrnayDArKTW9QSwNmly625G0qO49K
    zaALks019eSXNwxeaRtxJ9a6/w1pC7Fublc91U9653w9afbL2OPHGea9MgtmWIFRwowMUATRHAHapWYEjnn
    FUXcgdTkU03BUDNAF6RSRkMCfSs26hcg5gDepAqys6sD8w5qWGVxkpgjoQe9AHH6rp9tcQsNmyQdCe9ca0D
    QTgSjgNz9K9Z1DTYr2MtGfLlHbtXBatA9tK63C5we4oAn8QXFp/Y8cdtciR2IyoPSuUq7eRxeWskIwT1FUq
    APSPhRdJHaapbkgPKmBn8K67RbuWPUiIDJ5kibSR2FeefDWVVv7mMrksnB9K73w3exw3dxPJnj5R9aAG+O4
    LhLOxnuWlYO5Hznp9K5nwy/8AxNT9TXWeN9WXVNCMZTYLZtykdzXE+FnLakD6jNAGx4rdfITJ6Gr2mGfUdJ
    t5cGO3hXy4lX7zn1qnrNi92qlsBN3evRfCfhyWDRJdUKBBbqFghfoT/eNAGz8CTdr4piGqswtYY2ZUkPIOO
    Diua+NOvy6lrt0zMcGQ4XP8I4H8qd4b1e6tNZkkmyrsGTPue9cr4tZrzWIlJyWcIfxNAH1R8BtG/sf4baaG
    XbNcgzyZGDyeP0ArwT9tDxJ9o8QaXoMMgKW0PnSqD0Zjx+gFfV+gQi30PT4gAoS3jXA/3RX5+fHzVo9Z+LX
    iG4hJaNLgwAk9dny/0oA89ooooAKKKKACiiigAooooAK9K/Z88Sx+GPiZp11Pu8mbNuwBxndXmtS2szW9zF
    NGSHjcOCPUHNAHf/G/Rf7D+I2phBtgnfzowR2bmuU0uQxMbiFmG0cgV9AfG/QIvF/wx0PxvpKeZLDAqXW3n
    25/OvnrR540vNjDCSjac9jQB3GnSLc2ccoyVPXnvV5Q0S7kBIP61S0FEhtGiZhkNlMVoyNhTtYl89KAEYkI
    CcBz6U6JiVMcgweozRG4JwRgAflQQDuZyGHYjrQAR4ikIkLAnp71eW63Lskx8vtWf5+7BlBwOB6Gmyvg5Xk
    /XgUASalHHKVKAH1OKow2sD7jJGpUeq1IZCYyrE5J/KpSoCKpY+2KAIfJUrmNQu3soxTrZgJNxOGPTinouG
    IYYx2z1pTGFO0HC9eaALiTiKMnOHPXcOv0pkhEhGMqCPTFMCAxh8Zx0NIZDJhTkn0oAaR/CCNq9z3odwwyp
    AI7U1tobb19u1SSKghYgYb1oAolCJA2W57Gob9yLcsTkA1ZjjLJlunYmqeph0tpMfdA5oAoalrbW1hIkfV1
    wBmup/Zq8It4k8bNfTMUttPQ3DSFcruHQGvK79jNIoUknOAK+nvDtsvwt/Z4vNWkJh1bV12pnhsNwMfgM0A
    eC/F3xBN4k8f6rezyCQLKYUIPG1TgYrjafLI0sryOcs5LE+5plABRRRQAVreE/wDkatG/6/Yf/QxWTWt4T/
    5GrRv+v2H/ANDFAFr4h/8AI/8Aib/sJ3P/AKNaufroPiH/AMj/AOJv+wnc/wDo1q5+gAooooAKliid8bBnN
    RV3HhTTEmjhkCCZ2GFXrk0AUdGkvNLVGOnl1fneeuPau4TUkeGNoujjoT+lR6/Dd2arDf6fPZfLhSwIBBrz
    7UJrixdVWRwEbjBPIoA9H80MDmLg+1Qttzhl49q5LQ/FElrKi3BEtuT0bkrXbJc2l2oaILgjt0oArmOEgbW
    IakAaJwC3y+tLdRBAGjJwO1LERJAdxxigCzCg2ljJtft71neJdMXUYRsU+YBw3qfSrlvtZyJew4x601r2Wc
    RQHYNhwFXv9aAPKb2N4JHhkBXacYqLyC0e+Mlh39q7nx1ojCBb4R4Y8NgVyOjyCO52SY2E8g0Abnw7ilTWg
    +w7SpByK6ie0nh1ho4g21xu4pdAcWMjywxrhlwCRnA9qlk1ORdYUr97ZgE9qAHaxpk8Gj3UrEgBeh71y3hh
    salFXS6zfNcWU6zXJb5OF7Zrk/Dj7dSgLdQ1AHdvcW6TL9oQttb5V7Z9663XfGRl0O2sLCybEf8ArHzwTXH
    XbQRMZJwX5HC1sNeJewlbZIoIQuVGeW+tAEWls0l5AQxLuec/yqvewE+K7JSMlryMAfiKk0KSSPU42KghST
    04q7oaHUviFokZT712rkewNAH1l4x1X+wPA2paipCta2jMpPY7cD9a/NK7nkurqa4mYtLK5kdj1JJyTX6U/
    ETQH8TeBdY0aF/LlurZo429Gxx+tfm1qlhc6XqNzY30TQ3Vu5jkRhgqwoAq0UUUAFFFFABRRRQAUUUUAFFF
    FAH0r+yz4kg1bTNV8Baud1veoxhyemRyBXjvxQ8IXPgvxrfaZMGVEcvAx/iU8isHwvrd14c1+y1awcpcWsg
    dcHGfUV9XfFHRrL4vfCyz8V6Mi/2taxB3C8sQBypoA+fvDVz9qsVldRlODjrmtsFSd27DMPyrg9C1BtI1J4
    rgHymO119DXdja6goAUIyG9aAHnKIFX5znk0jrhSRgUiZUDI3fTtUiKkgIz05xQBEUKqNoJz19KBCGGCOf9
    k1KZgzBZFKY4GO9H3TzwO3vQBXkh+YY6CpFAVC3OfeplcD7yruNVbi42KGbCoDglqAF3qFLONxPampKd2DG
    PbdT53A2AY+boexpWUbsP8p6/WgBd4AwzZJ7LwKHyMbFAJ6mk2cZCYXsfWl25jGVx7k0AOhUK2GG49jUGfM
    lcK3yjqKeMuNoYKo/jpmRGMIuQepoAlMgUYA6dCK5/wAV3TLAqDhT97HWtuWSKCMkkNjrXBa1ePqmorDaqW
    BIVVXuaAOy+BHg2Txl8QLKN4y1lbyCWZscBRz/AErr/wBq3xjDqniG38Oaaf8AQtLAU4PBbGK9K8Haba/Bf
    4MXusX6ga3ewllU/eBPCj+tfImq302p6lc3t0xaadzIxJzyaAKlFFFABRRRQAVreE/
    +Rq0b/r9h/wDQxWTWt4T/AORq0b/r9h/9DFAFr4h/8j/4m/7Cdz/6NaufroPiH/yP/ib/ALCdz/6NaufoAK
    KKKACt3w74hn0RvMhG6WM7ot3QH3rCooA9y8G+P7vxxu0PxUEuHf8A1M6qFKccD9K4DxzpT2FzLCefLkKg+
    1a3wIt4rnxkEk6hcr9Rmup+JGlJNd3OV/5ac0AeRwWisod+FYYNauhF4Ls2dzIyqBuU+1dd4b+GGsazJIwd
    VsYAHL56j0rP1TTorXxpcQlx5MEWxm7ZoA1YXtxbErceZLjADU2NF8tsuAOuKwnAiciM5XtU0V60YPAI9DQ
    BoKTI5CchRkntVyKG2tZLS6Y7lc4kCnpWFPqe2IxrtRT1Cjk102j+DdeutAl1iaPyrOYYhhf70o9QO1AFvx
    ekEmlGCA+YmODnnFeMXERtrxlbgqa72SeZFe2mZ0HQbuorkddtTHLvL793egDq9Cu/MsUHXIx9KcyrPqUQZ
    woIwTWL4XuAsbRMc56D0q9eP5dxE4PAPNAG1qUFlHpsyb1eRl4x2rj9MlEN0uB1YCuhDzXCuUhXbg9RXM2a
    f6btc7cNmgDtL2J542OCFI5rd0Tw8JdDNyk6FoyOCelc9PM5twISSCK0dJhupdBuW+0tGFbLIp60AaumXSR
    SyRHBwSCfetH4eCSb4o6KigbtzMAT9a5LS7yGKVjMdxIz1ro/hZdLdfEvTnlbYrKyqQcYOOKAPs60kaW2R3
    GGI5FfH37X/gP+ytdt/FVnt+zag3lToBjbKBkH8RX1P4c1RHtVgk4eMkNk5xzXJftFeHR4l+FWrRopea2T7
    VFt5JKjOPxoA/PiiiigAooooAKKKKACiiigAooooAK9m/Zx+JP/AAiHiFtM1aXOh3w2OjcqjHvXjNKOKAPo
    v42fBy4SK88U+FGhvtJnbzjFCMtED3+leQeGddMJ+yX0hAzhGPY+hr0P4H/Gi58L3CaP4iIutCmGxi3Jjz/
    Stb40/B2JLN/FngV/tmkzfvpYkO4xZ5yMdqAObwViD8Nu6be9NIwPlTazda4PTPEN1Bb/AGO4BdE6Hoy1v6
    NrizHy7iZSD90twRQBs4IGxlLe5NJJJIeEBA7d6s7FZPlOSR+BpiBgMMuT6igCFEZSNzDJHJxWD4uY/YYoA
    W2s2Rjua6YSbYy21SPU1j3gS7u4Uc7YY23EmgCl4Ymur22e3ncmWDgKx7VvMhyN+3gemaoX1mLbVP7RsZFM
    Uq7Sqnn8aminI4Y/N+lAFpvmjAHP0HFODKOGAx6Gq/2gJuV2BX/ZqW1Sa9IW3hZx/eYYA/GgB25FXJZT9T0
    rPl1KG33fOzD0HA/Ok1qbTNKdhezfabpR8sEDZUH3NcVfXj3lwWuPlU/dhTjFAF3VteadHSEAA8DFep/s1f
    DmbWvE0etaxbFNMsz5u6UYDEAn/CrHwP8AgvN4hnTXPFUb2miQfOiN8plxz37e9b/xw+L9jpdg3hjwMIoYw
    vlyzxdh6A+tAHF/tK/ENvFPih9MsHA0yzHlrtPDEGvFKc7M7lnJZicknqabQAUUUUAFFFFABWt4T/5GrRv+
    v2H/ANDFZNa3hP8A5GrRv+v2H/0MUAWviH/yP/ib/sJ3P/o1q5+ug+If/I/
    +Jv8AsJ3P/o1q5+gAooooAKKKKAOg8Da+/hrxLZ6iuTHG2JFHde9fTeq2Vr4m0Eajpaxz29ym9WHfPb2NfI
    ldX4M8d614Tkxp1wWtictA+Cp/PpQB6bpV/wCLNDmls9KspZ3UFV2jOM+ta/hP4YahrttdXV9P/pszEyxuC
    GVveqeh/HvT42L6po
    brKRy8DA5/lXV6b+0l4ctpFUaLeKp6vhc/o1AGHe/BC/UkLMY3A5w3BpdO+BNzNIDd6vtTuEJzXp1j8d/BO
    pxqXv8A7K56iZMYrRb4weAIF3HXLYgDoq5NAHO+HPhTpegX1vPZWiXUqffe7w+T7DivYdI0iGZRLfQLI+3a
    Ay/KB6AdhXk9/wDtD+BLNCLdrq6kXoUh4P4k1534t/ak1K4ikh8NaalpnIWaYhiPcLQBD8drSKb4h3WlaVY
    x2/2eLzX8sYyOOT+deT6tZgWxj3bio3FjXqfwat7zxKdc8R63O11e3cTxmRvz/pXmd7DPJqFzGMFY3aM/Sg
    Dn9Jby7xQCQAa6fV7ZrdYpXX90xBzXOLEbe8Ifgg9q7bULdL7wsJIZgxjGSp6rQBROo4iCwiNQRgH2rlbwk
    XjhDkk9q27C0MsaPIQFA6VS1aKGK88yHlQQcigDZ0+WX7AmQBgYzWrolwSkkUY4YFWH9a5zTNQSVpI2yADx
    W3pGpQ6dqkLggo/ynIoAybi3kt7phJlUDEDnrV/Sb+XSNYsb+3Y7onBz14zWrrLWtzHIygZYkgjsa5SWR1A
    xlihzgdxQB9deHNcW+t7a7gkUxzKNxToTXZRagt7pE1rIwKSRPGN3c4r51+EesudLnt3VgAwKj0r1jR9RZZ
    HjbO0HIz60AfEvi20Fj4m1O2AwI53AA7c5rIrtvjLai1+ImrhRhXk3iuJoAKKKKACiiigAooooAKKKKACii
    igAr2L4M/GO78GsNN1UG70aQ7WR8tsB68V47RQB9U+OfhP4f+IWnnxF8OrqCK8cb5bQEBWJ9PQ18663ouq6
    DfPaa1YzW8kZwdy4P4Gjwl4u1nwrei40a9mgOfmQMdrfhXvXhz41+G/FsKWHxF0iF5SNv2kquPzxkUAfP1v
    qV1b4EF04x/A5rZtvEmoqB5tskqDuDya931j4G+FPFQN34N1yCLzBlYnbIGeg61x19+zx42098WjQzrnqj5
    oA8zuNR1bUZWFtEYIT2qzHYPFbiW4umllHbPArt5/g58Q7R8HT5HXHVMkfyqjJ8LfHLSY/sq43HjAQ8/pQB
    ycs0phEQJIPcHpT7S4vrLiFg69fnGa66L4P+OhCzNpcuR/AVOf5VAvwr8fSziOLRrkjuQhwPqcUAc7deILs
    ji3twwHXH/16yrzWr+4hCS3ZWM/wR8V6hZfs+
    +ML+UGaWC2U/eMjYArr7L4PeDPBNql9441yCZ15MStgE+3PNAHg/hrwrrXie+W20SxmuCxwX2nA+pNfQvhb
    4R+Ffh/aLrXxB1GCS6jXettkYB9DnrWV4o+O+iaDprab8O7BIAF2icRhfx6c18/+JPFGseI7l59XvZbhmOc
    MeBQB6z8Wvjrd+IbeTR/DiGx0pcoHjJUsvTtXhhJYkkkk9SaSigAooooAKKKKACiiigArW8J/8jVo3/X7D/
    6GKya1vCf/ACNWjf8AX7D/AOhigC18Q/8Akf8AxN/2E7n/ANGtXP10HxD/AOR/8Tf9hO5/9GtXP0AFFFFAB
    RRRQAUUUUAFFFFABRRRQAUUUUAfT37Pjh/h7drHgSKz15NcTeXrF+rdfNb8816B+zldj+wNSty2MEmvOvEI
    EPiq/QdPOP8AOgDFvnK3W4jnPPvXTaXc+d4duAi7HzgD1Fc5qn+tjIHetFb5oFjVQFQkdKAKsV07oY8428V
    Hco725IXjvVqW3SPUZFxhWG8Zonu440ZFUN7CgDNtoTbypKp3I459qu3BO+PbnOaybp2LgQFtmcgVfE0iQg
    8ZxkE9qAOjsra8upI4cEqRlsdh71JcacdPbzFG885Bqpo+uTxoNrqHPBI9KnuNVndGVyCOuaANTwJr4sNaS
    3nbZDcHB9j2r2mxvv34O/nHNfMd7c+XLFKOucjHrXsHh3WfP060mJJJQbs0Aee/H6Lb40Ew6TRBv1rzOvVP
    joPOvNOuh/EhU15XQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAaej69qmjTrNpl/cWzqcjY5x+XSu9
    0/wCOnjqxxs1NZOMfvEzn9a8vooA9nh/aN8cRsC0to+OzIcH9avxftJeJ2lDXMFvj/pmD/jXhNFAH0DD+0v
    r6SZe3jKjoNv8A9epp/wBpvW3U7LKNW/ugYB+vOa+eKKAPYNe/aA8X6rG8aPDbRkcCMHivMNZ1rUdZuWn1O
    7luJCc/O2QPwrOooAKKKKACiiigAooooAKKKKACiiigArW8J/8AI1aN/wBfsP8A6GKya1vCf/I1aN/1+w/
    +higC18Q/+R/8Tf8AYTuf/RrVz9dB8Q/
    +R/8AE3/YTuf/AEa1c/QAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQB658BL429xqURPDRk/wAqwPF7Y8S3Mi
    c72zWp8J7Z7XTtR1BuE2FRWPrbma9870PWgDNvlcsHYfKCDipnmWJxld3HGasavPG3lBAASoBqhqRKx4YY4
    4IoAtao8ssUVyODjYcdqoRZ6HknqauadKs9rNaO3zOm5PqKrwyxpCC/Dd/rQBHcQkFSvXtUkd2k8PlsuGU4
    BqtJdMQTGOnIzUHn/wCkA7QNw5HvQBp2Ue+VkTIYDI9DVxYpy4MiHZWK109vKjocVpW9/LK25m4H8NAFm9S
    B4FKrhl/Sul8L6ip0tYw3K8GuPlulBZWHDdDSaFfi3vWRj+6fjHoaAOk+JsxutCsXPOyTb+leZV3fie4+0e
    HZFYfNHIrfriuEoAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKK
    KACiiigAooooAKKKKACtbwn/wAjVo3/AF+w/wDoYrJrW8J/8jVo3/X7D/6GKALXxD/5H/xN/wBhO5/9GtXP
    0UUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAb9r4r1O1002Fu0KW56gJyfxqlLrN3JGUYpg/7NFFAEcup3E
    pUuUyowOKLnU7i4UCTZgei4oooAgjuZY5VkRsMvSke4kZiSRyc0UUAKLqQYxj8qYZmL7jjOc0UUAPlupJR8
    238BSrdyrjaQMe1FFACteStjJBx7UwXEgcMCMg5oooAsXGp3M9u8MjDY5BOB1xVGiigAooooAKKKKACiiig
    AooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAK1vCf/I1aN/1+
    w/8AoYoooA//2Q==);\">",
    " </div>",
    " <div class=\"lgnd\">",
    " A) There is diffuse expansion of the pons with mass effect and displacement of
    the fourth ventricle on this sagittal T1-weighted image. B) Similar findings are
    noted on this axial flair image of the same lesion.",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6354=[""].join("\n");
    var outline_f6_13_6354=null;
    var title_f6_13_6355="Fluoroscopic image of tumor ingrowth into a metal biliary
    stent";
    var content_f6_13_6355=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=GAST
    %2F57138&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=GAST
    %2F57138&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\" style=\"width: 470px\">",
    " <div class=\"ttl\">",
    " Fluoroscopic image of tumor ingrowth into a metal biliary stent",
    " </div>",
    " <div class=\"cntnt\" style=\"width: 432px; height: 432px; background-image:
    url(data:image/jpeg;base64,/9j/4AAQSkZJRgABAQAAAQABAAD/2wBDAAYEBQYFBAYGBQYHBwYIChAK
    CgkJChQODwwQFxQYGBcUFhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChM
    oGhYaKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wAARCAGwAb
    ADASIAAhEBAxEB/8QAHwAAAQUBAQEBAQEAAAAAAAAAAAECAwQFBgcICQoL/8QAtRAAAgEDAwIEAwUFBAQAA
    AF9AQIDAAQRBRIhMUEGE1FhByJxFDKBkaEII0KxwRVS0fAkM2JyggkKFhcYGRolJicoKSo0NTY3ODk6Q0RF
    RkdISUpTVFVWV1hZWmNkZWZnaGlqc3R1dnd4eXqDhIWGh4iJipKTlJWWl5iZmqKjpKWmp6ipqrKztLW2t7i
    5usLDxMXGx8jJytLT1NXW19jZ2uHi4+Tl5ufo6erx8vP09fb3+Pn6/8QAHwEAAwEBAQEBAQEBAQAAAAAAAA
    ECAwQFBgcICQoL/8QAtREAAgECBAQDBAcFBAQAAQJ3AAECAxEEBSExBhJBUQdhcRMiMoEIFEKRobHBCSMzU
    vAVYnLRChYkNOEl8RcYGRomJygpKjU2Nzg5OkNERUZHSElKU1RVVldYWVpjZGVmZ2hpanN0dXZ3eHl6goOE
    hYaHiImKkpOUlZaXmJmaoqOkpaanqKmqsrO0tba3uLm6wsPExcbHyMnK0tPU1dbX2Nna4uPk5ebn6Onq8vP
    09fb3+Pn6/9oADAMBAAIRAxEAPwD5UooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiinxxvLIqR
    IzuxwqqMkn2FADKK6/R/h9r2okNJbrYxH+K6O0/wDfIy36V2mkfCvTYlV9Uvprl+6RARr9O5P6UAeOVbstO
    vb5wlnaTzsegjjLfyr6FtPC/h/TYlFppVqJAcb5B5jfm2TWTq1s1jceZExWHOfpQB5tB8N/E0kTSS2KW6KM
    5mmUZ/DJNFp4Du5XKzXttHjk7dzYH5CvXo9c+06TKIo5GKRkF8YUfjXGR3ccMcu9tzyDGRQBxmk+HLG6ufJ
    uNQlQk8MkQI/nXUz/AA3sRHut7u7kOM4+XkflV/RPDaXVjcTWZHnIudrHr7CsKLXbzSdS8t5GDKcFDzQBLF
    4Q0WF1F39tZejFZAuD/wB81v2Xw88LahaPJbTagMcbvOUhT/3zVe/u5dUjSWGMFn+8QKh0HzLa9FvJckRn7
    yA/zoAfF8NtCkuGiXUb7gfe+TGfyon+EMBjH2bWZd2er2wxj/vqu0ilCwKUETKWwVQ9vf3q3DdLE2eVB4x1
    oA8m1H4W6lbkC2vrSfc2BkMhx69DXO3Xg/Wrecw/ZVlccfu5FP8AWvf2kSQA/wARPfisHULZG1BWBwSRz2o
    A8Kv9MvtOI+32dxbZ4BljKg/TNUq998QwzXPlWTosiHnaRkA+tQ3/AIb8PnSHN5p8JdE/1sY2Nu/4DjNAHh
    FFdDPocT6h5FvMUDH5dwziprvwRrUQZrW3F6gGc2x3Nj/d+9+QoA5iinyRvFIySoyOpwysMEH3FMoAKKKKA
    CiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooqzY2VxfTCK0
    iaRz6DgfU9qAK1bPhrwxrPia7+z6HYTXTj7zKMIn+8x4H4mvQ/hn8P8ATLu/Y+IG+0uoylujEJn/AGiME/T
    gfWvddFubXS4TYxRJawoMJHGoVV+gHFAHkug/A+3soluPFepeZJz/AKLZ8L+MhGfwAH1rpbHTdJ0lGTRLKC
    2QfKXjHzt9WOSfzrovEOoSOpSPnd+grlpWEZ2g9evOBQBYkkfYXDDB4z1NMW4LSLhQPciqskpK4UfhT7baq
    mRzsI6lqANEtk7iQExnPSvPvEnibaslrDEsiAkBjzmtHxVq5kAgtZldCMOEPX61yMdul4WQFd56ZOKAJNI8
    WXCJPaug8qRdmAOBmr1np9oY/N1C8W3gHO7qT7YrH1jSpdP2B9gkwMAVWvZVksVFzu4GAAehoA9S8I6z4fW
    F7TTLvcxHPmD7xrzzxZp8sF+8kseQWJDY6iuLtJ3tLxJYiylT616bf3supeEGuPMjJhx8j/xA9gfWgDDi1U
    RaawiDIw4JrHTXJYpUcMGUHJOOTVFrxjvG056cHgVnP8z5XNAHsXhDUodShf5j5qjO3OOa3o5Q6ggZx/e9a
    4r4eWbwadPqEy4iI2KfU1p6brGzUGglAKv8vHagDpg4UEr6dM1m3N3H9rBAY/Qd6luJYlfas0Ykx90thqzY
    Fka+8wEg56GgCfXV1QW6zWMkayOwAL8YFQ+IZ5YdItY58Gdhl8HOa1b0NcwFAjDYcj1rjNa1Ca7vm+YCNMI
    Fzg8UAVBZgqLv5lZTgbun510mm3NzDOhtZMFvvcZq3ZWES+GlMq5djuAJ7VRVmtJleDlgeMcfrQBr6tpUOt
    Iv9swRTHacMVwyjHr1H515fq3hKNDK9hcbQD8scvII/wB4f4V3GoeKEiuGjnRkkZcFW5xVTRls7y623UzLE
    3XA/SgDyy+0+6sGC3cDx5+6x5VvoehqpX0NqehxpZn7CizwFcNBLhlYfSuC1jwPZ3zh9FuI7a5PD2spO3Ps
    eo/UfSgDzair2raVe6RdtbajbyQSjpuHDe4PQj3FUaACiiigAooooAKKKKACiiigAooooAKKKKACiiigAoo
    ooAKKKKACiiigAooooAKWruk6Xeatdi3sIGlk6nHRR6k9hXWy+F4tKVQ0hluR96UD5QfRR/WgDntN0V5WV7
    wmKPrsx8x/wrvrS3gtbGNbSNY04OI/X3zyay4bZpV2O6kj+I88Upt54nGwl8jjaaAOr8NXjW2qo3AYNnn+t
    d/4m1G0Sx8+WYLMBkRoOW/KvDHvLm2ZSd6YP41v209xqFmAoYP1564oAtyeKbozNhn69DQfEN2zguRjsMDi
    q0Ohy+Z5k0gC91HJp8ukLLg28iZ6necUASP4jnLbVVQRxnFUL/VZ7pNsjtj07VK+kmHaHuIwxHOORWdqFtJ
    bxny2RyenPNAFUzmKYAAkniq2qW91b3KzKjKQBgVJaQMkyyzSFnz0HP61vtC98Fd1LEcc9PpQBBYMNUsomu
    Qd8ecnOc1h+JrZ/JRl5dTyB3rs4dM8qDEWF3DJUVjahpVwG3uheNTyQaAOHgs5JSu4bee/euoiZotElsyQV
    JDDPtWtb6ZK0HmrD8g43bayL2Nom+dGUDr70Ac4kAYbhnJzxTobdUbAINaJtGIZojg9cVQ3sDtwM5oA9N8P
    XCXGiW9nGNghO4+hrmdWiu7S5ubr7m3JGe/pitn4f7IUlebLB8cZ7VZ8XOs0+5jlU6DGfwxQB51afbbrzZ4
    y7lBuds13/g/xDYtFHDdShbk/KGPSuYmljS2u4LXNukg3yL2YDsO9crE0izKy5G09qAPoC4GEZsfKoyGUV5
    2YRLrGwltsj9+orR8J+IFFq1tdO7BuFG7p+dQC4Ed1K0SKZP4Sw6UAdrfR+TpgjjVWVQOnpXG32tfZGKBVZ
    x0HcGp21O9msXguLjbsGcL1NcXd3Ya4yo3EdyaAOksNLXXtRPmgktz8vWuuj8Px2EsMSKGAGcjqK4bwxc6h
    cXinS9yOnLleRj3r0JNUT5Zb1jG6cPk4oApNezaZPgtmDPrwKTULSDVSl5Yny7pDlWzgE+hFbssFrfQfwuj
    DhhxXIarY3WkzloOYWPGDQB0kkFrqWjCDXYIJ4wPnyM4PqD1B9xXlXiLwPIkktx4eEt3ajJ8kjMij2x94fr
    9a7aGC7u5Vdbkm3ccxgYAP9a7HTIUtbZUjGHXq2OaAPmEgqSCCCOCDSV7f4t8H2fiPUZmjK2uoMu4TAfK59
    HHf6jn615DrmjX+h3zWmp27wyjkZ5Vx6qehH0oAzqKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigA
    ooooAKekbOMgcdzU1tavMu/BEY7+v0rSgWONCkg+Qjj2oA7r4WXdv9mnsNqwz53Bl6sff1q/4hgkQu/ysSa
    810m9m0zUku4udjDdz2r1K4uTq1nHcQqrKy7sLgY9qAObTBcFVbJ44rWsYZLhi1tGpI45GMVnyxiPlVPHPP
    FXLKYpny5CWYYAzwKAE1SzuJNiCAOF9CCR9Kuw6ja2MKxTMYpFXBXq1TfaVS3eNHAmI5YnkfSsq9slNqzeW
    JLlvut1I+lAD5ddRixtI+MdWOc1ltqE08pZ3Iz/AJ6Vf0nQb6aNmlhaOM8l3FS/2IsNwNz71zzt+U0AUYC7
    yFC+W9D1p0kE4LcHB9a247a3t5sxx4PbIyB+dXA4JO4fUjoaAOY03bBefvIwUPBBrsbc280arEn1B5NZN/a
    RvE0iEK47Yrn7TVJre8UtwmemaAO6AEXGzHbAGKeGDph8YPUZxTQ6XEaSI4JPJzSHCsScHPegCkxl0xg8BZ
    oGOWTPIpbmwsdYg82MBJj1FXcb1J5rNuENtdRTRfu2duRnOR60AVh4aljU5ZNoGBgVw2sWosr6SNsM+eoHF
    exwXCNtXklu4GRXnfxItDHeJcIpAYcn3oAi8L6gRFg5ADc4rr/ENrbappcc1ncILmJQHjPBb8PWvOPDEwin
    YScK3PStPULuSQyCJiAem04oAw9TjktLlQ45wfyqMvCNOeNUHmlwVb2qHUZHM3zHkDHJqukhbjFAF2wzBcI
    7udo9O1dXamW9YLaRCTA69DXOWFkZCWkJHGfr7V6H8O5LMTyrgLOBn5jQBzuqeZawyCcMJSMZI6VyFw7fdX
    v3r3zWLSG7tZnnRAiq2CR+teEXqbJ2C5CgnAoA6H4a3T2+vCNidsi7SRXpGvwJNZyMEUyJyCR2ry3wLDJJ4
    hgKcYOTXsE43FhkEYxkcYoAz7eWVLWJo1EilfX7tXJI1ubQwzH5mH3vesUPcWN+RtR7RzkAN8yGtmW9t7a0
    MruCeyt1JoAx7Xy9MlMd0SFJ44710EBfyRJH901yOuzG9tjcxnzAvUL/AA1X0PU5sCJ5Sv8AdPXNAG5YXQl
    8TFYWaTaDvPauj1nRdO8RaU9nqkAkTqjrw8Z9UPY/p61ylrfrZ6xCZUVYpOGYY4rtSGVvlJCEZBHegD538c
    eDb/wpeKJ/31jKT5Nyg4b2b0bHb8s1y9fWtxBb31lLZX8Cz2ky7JI25DD+h9D2rwP4i+ArjwvILu0Z7nSZG
    wshHzQk9Ff+h6H2oA4aiiigAooooAKKKKACiiigAooooAKKKKACiiigApyjJ54Heur+HPg2fxfrPlO72+mQ
    fPd3QXOxeyjtuPQfn2r1L4z+FNKl8J2l5oISE6PGIfLC43w/XuQecnrk0AeKWtx+78rqv8PtUhiYnocVnQN
    tYE/hWi9xvAYcdiKAI5wF+QAHPU12Hw91Vbef+zr35UkHyHPSuTa2MkRYk4HIpqykvHLErCSM9qAPS/EsTx
    kG3DmP1IBNYNoLuedlU4Qerf4V0FtrT6n4Xaa2RGuIhtcdWAHesbSYZ3zu3An5m20AXbCxeSQ5l5HU10dra
    x2qBx80p7txj6Vl6I6tfGCRiyk4HH9a27r91IRheDjBoA3dPXdbf3ietYerWe2VzHhcnPBrf01g1ugHXvx1
    qlqkCsjFWG8c4weaAOYKGNxu3YPQk5zU6DBBC8Dpjg1IfmLBt2OhHtSFAFyAMj1oAayq64K4z1ya4+5sHTU
    GQZwzcZNdkw+6RlTjnAxWNeLm/XpnI5zQBq26+TBGhy2ABnIqZLrBAKDAHU1Ht3cge+O9IFyp29vegC2sgI
    28En0p0UXBLDJP6VRiG3OcgenSrEMzA/NuOevtQBbs5fL3DbkKeDWJr8CXTSCXJGelbcbg4w2QT09KpaxaO
    2JolLA9QOMUAedX9i9k2U+6eQahtL1JFbzMrIOM+tdRfwLLCY3XP1HSsH+zER+WOPp0oAxr0Brhucg+9QBH
    BOehrT1CxkUhvlwOpqlNmJPm9eKALekXscEipcnEOevce9a0WoR2Gopd2U6yKCMg9xXHvyTTo5WQ4HT0oA9
    v1vVH1Pwgk1nHw7bZCpzjFeX3EBLEtyc961fCuptFavDbyZQ8vEx4P4VLqCK5yo2k9sZxQBJ4GTyNVaRV37
    VJOOK7a5vZZiegQenArD8L28NnavM3zTP91fQVfnWa6f8AkvagCCf94SI3DnGcLWPqTOWIydy/jXR2uiz7j
    IylccAdPzpJfD8zuQowScc9PrQBzWj6nJY3W98bP4lIyGHpXU3VzpV9GrWyrbyH+EgDn2NYGqaTLZzGOWMZ
    zw46GqyxERbWPGKANeS0kW5iNypLg/Jhsg16VpLia0ETktjpXjlnqE2n38PngyRBgOTjaPavSdIv4VvMwMW
    DDcFPUUAdN9mT+DI71Dd6elxay291GstvMhR4iMhh6GtBGDplTT1yD82MexoA+YfiH4HuvCl55sYebSpmIh
    mI5U/3H9G9+/5gcbX2je6dZ6tp1xY6jAs1rcKUkRu4PcehB5B7Hmvl34k+CbrwZrRgbzJtOmy1rclcbx3U9
    tw6H8+hoA5CiiigAooooAKKKKACiiigAooooAK1fDWh3niLWrbTNOTdNMeWPRFHLMfYDn9OtZiqWYKoJYnA
    A6mvp34WeDF8I6C0l7EP7au1DTn/AJ5L1EX4dT7+uBQBr6D4dt/D2nWujafhLaMbpZAuGmk7u3qT+gwO1b9
    1pNhd2bWsqfu5FKsAeoPBzUFy4DRvv5HWpYZxwWbAPQdCaAPlj4jeEbnwd4gexlPmWsmZbaX+
    +me/oR0NYFo4QgSfT619JfGHQn8SeGCtvbNLe2pMsLA4I/vDnsR+oFfNDZ3lGBR1OCD2NAF5JBkoSSh6GpF
    EllOJMEA9qrxAEbX4YetWGma5iWJ+XT7v+FAGh4a1T+yNXWbhrdzh1PQivUyITLFPa7Qk43KF6CvHI2Itnh
    YL8x53DkV1PgfWjBLHY3TKV3fIxOcUAddpUKi+lfODz8wHer9wxkl2nG5e3rToLUfbJmRm2nkAf41ApP25k
    AGCTQB0OlP/AKKgwT25PSnXakKQOAeuVNR2OFiG3HpU9yNyoWJ/CgDCv4NvzqTtNUdzbsY+XNbjqHbJGB0w
    az57ZlJdMEDsO1AER2MvT8c1iXEcjX52njditdxhun5VSbKXyns1AFoFsbXwxxg47U5QgU7QfpipXKtg45A
    65qPYD8xA+b8KAGc9V6f3QaVMBj83Gc4zmgFQcc9eg5p4UA9MemB3oAkBUnkYJ/GrEM3JDjI96rbBnJGQff
    GKkKkA4Jz2FADrvSo7pSYuHxnGeK5vUbBoco/JXiupgmKKBuHr61ceGDUI9sqgP2b1oA8snQg7TkDpjFc7f
    kGdxjgHGK9G13RZ7Ri7RnBPXHB/GuBvrYpfOsnGTkcUAZOOeelIwrQuYhDH869ehqkBuOaAGxO8TB42KsO4
    rodP1R5lVZHBl757isBoyozg4NNR2ikV1PI5oA9J0bVbeFyLiH5uoIFdzY63pLwJvuLe2cdVYYrznSmtdSs
    d4XY4GHUHvUGoWRi/1LCRR7YIoA9gt3iuYw9rKkyddymgo5fjjB7ivGtL1a5024jktpXVwcbc8H617N4dvl
    1nS47kIFk+649/pQAXFul3F5U4yAeCBSPoGmXKqHiKYH8JI/OtF4iuTgA9M01XYPwckDp6igDjvE/g6T7FJ
    JZnzCBuAUc1gaYNReNfL/dzRfLjGCPrXrPLqASeRjArCNo0OpO8ZBJ+8pH3hQA3w3rs7p5F5B86D7y966yy
    uobjo2T9Oa5m+ijjYTWSlWHLKB0q5pt0ZQNwEcg6GgDq0Hr0qh4p8O2finQ59L1FA0UnzRyYy0MmDtdfcZ6
    dxkd6itL9lkMblSR09xW1BMGGQCKAPjPxToN74a1260rUk2zwNww+7Ip+66+xHP6Hmsmvq74u+CE8Y+HzLZ
    Ip1uyUvbseDKvVoj9eo9/QE18pspVirAhgcEHgg0ANooooAKKKKACiiigAoorW8LaHdeJNfstJscCa5fbub
    oigZZj7AAn8KAPSvgH4OS/1H/hItTjzZ2b7bVGHEkw53fRf549DXtV83m6kkW4hSpYjNSaTptrpGl2um6eh
    jtbZPLT3x1Y+5PJPqazrhxBq0cjMdu0qx9MmgCK+uBbyiMZ8vPBNXLeQEBgCc4rI8QMVnhkVlwOx5Jq3p+9
    mAdWCnkDHWgDVuGHlZ3YB7d68C+MHhT+zNUXWbCJhZ3LYmCjiOT1+h/nXukxZFAwoH54qG8srfUdPuLC7VZ
    beZdjIRng/1oA+UgRO5wcsPXvU0Y2kbvlcdK0PEvh668NeJLiwuDtCfPA5HEidiKpylLsb0+8OoHWgCIvmY
    5HJ61Nc/MkSxIElj53jgmoSCU6fMOnNPt28zCMcMPegD1P4d62moxGG7IFzGuPmPWtfUkMFzHMANu8huexr
    x5bk2GoRXWngqY8bhnIJ716/pWqxa5pCzADzO47igDZswpjy3Kj3qWX1UEjt6Cq+nr5YOcjBwBWkwAj3MSR
    jk5oAzvJJ+8OMenekji3NhwSnXJqzMcDEanH0zVaORvNySDg9AaAM+9tQrsU6/wB31rDuQY7tMj061192Gd
    d457EelYGpwqxRmIUg4wKAAnJB/GnHDAEjn3FKYyqAqcqR1FEabuSCQaAIShDcDPvUh4XkD/CpVDDK+npxT
    HQgn17cUABVcBzz6HnrUydOTkH0xxUI3JglCDUkYLHH4ZPNACtwAuDzxk1JCxXjke1I4LZ7gjJ7YojQjcM5
    J7igDasZ9/EmGUeozXM+NPDMElu15Cp2ZztXqp/wrbtHIcmMY7Y9asXkhIjUgYPBHY/WgDw3VLZyBEf4eh9
    BWWu1cDqa9K+I/wDYyxCPSpC163+tC42L68+tec/Z3/3aAGltxAPI7VDMOenFXEg+XJ70SwLsJzzQBseBrq
    JPEFmlycwyMI3+h4r1TXvBLxTk2MhaNwSGbjaK8S02QwXccpJ3IwIx1zX0hb6nHqHh62uVlXLxjcM85oA8c
    utIkW5eORVV0bBYHrXe+A7o2aiBdpjc8j0xVq506C88wQKv2vqyt3HqKl0/RZoCAQxcevQUAdLcusRGAzs3
    3ajCkDBXGT2plqxlk2yA5jGBmrYXPBGKAGqoAwM5Pes+/SSKWKcBeDzWqEPHbjFRXkIktnU5zQAtvsnLY5V
    ucVVutLGQ8XymnaO/7oqxUshxx1xWuudvzDNAGPCkpU7sOwPbgitTT7wsvkyNslU9cdR7VDcRmKZZlHynhh
    RcwCUhoiF45x1/CgDft3XIJz7GvAv2g/BA02/HiXTIsWV6+27RRxFMf4vo/wD6Fn1Few2d1LBhZQWX9a0tQ
    tLTW9GutM1BfMsbuMxuBjK56MM9CDgg+oFAHxNRWv4q0K58N+Ib3Sb7Bmtn2716OpGVYexBB/GsigAooooA
    KKKKACvpD9nrwkdL8PXHiK+i23d+NlsGHKwD+L23N+ij1rw3wP4fl8T+KtP0mEHbNIPNYcbIxy7Z9lB/HFf
    Y8wjttOEECpHBEgjjjXgIoGAB+AoAoSMPIyWycnFc/MweRlc8nI61tHJjAK4GKyLpogZAcM+eFXrQBWa3Mk
    sIfkIc4HT8fWtkkbN3HSsJ7udHImIjQe3IFTTXAEcY372IB570AXLmcHGELL2wcU6KVsjaFRmPY5xx1qrbu
    WByoC5/GrIPO4NtAHbpQBhfELw2niTRDGGAv7cGS2dgMg45X6GvnWwhuVupFWMJLASJEbggg8ivqJCZEYqV
    yTgZPNeY/Fjwom6XXdLVmlCf6TGv8Q/v8d/WgDza6EcuJIumfmUD
    oaoSrtYOmfU1PZCSdi9rGScZYDpj6VM6pIPkJyOSuOc+1AEFo/nSBGKgHgk+lbGh6tJ4e1ksGMlk52sOoI9
    cVz8ilGJXNaOjpHfSLasqh2OQxOKAPeNPkgvrOO4t/nRxkECp3dgQjcgc5ry3wL4ol0DWGsNSY/YWbap7Ka
    9XuAsqLIhV0YZVh3FAFcsCc5HHoe1QyjJBHIPOAKkwV4YgL6qMCghQpwOe2aAGYLoVwWAP5Vm3sPyPkYx+d
    aoUo4PC/wBKqXqDy2yCcg9eMe9AFWyINsvIOOvNSMqlMgHJ4yBVLTJd8ZUZIB7jOavKAVIHzj3NAFcwYPy9
    6byBk8Ec9KstHuztXnOc01F4bkjnlSe9AEKhWbHc85qQKy54/E9KkEYJ5XHpxTo4irHjIHTBoAiVcHLAnvn
    HQU9ISSoBBB6c/rVhV3cBSR0Of/r1ZigG7OFCj0FAE1tESOVC47n09a4fx5r6ND9ismOM4dx1P0rf8Samln
    atBE5MjLyEPSvL70vcXJ/mKAKUzliWyee+aiI45OamcYYjjINRkDPFADVB6Ukg29OhFSRgBuRRIBtOOPrQB
    nhtsxOQRn8q9t8F6e2qeC1eFstGSMHgcdq8RmUFjjHHpXtnwVu5JNAvINudj9M+ooAxNOu7vSdcZrgNndwG
    r0+wvY72yFyhwMcqeSprI1TSYJNQgWZQdw4PTBrG2z6XfeQ8rxwlsttH3h9KAOztoxGpJOZHOTU46jApLWW
    G5iDQur/Q9KWR9hGfpigB6+lPVAc4xz61GpJ6jA7ZqzGpA6AGgDHObTVQNuVl4PtW0iAcHn61l6nAZZPOUk
    mPnA61o2ci3FurLycYIPUUALdHdEUX06+lQwkhFZRkirDKApySaS1GIxkDJoAkmt0u4t8Rw+ORiqVjcPYT4
    n+aM8FTV+OJ0JZSQfSkvoori2YyJyo596APPv2hPCS6z4atvE2lxb59PXZcherQE9f+AsfyYntXzXX2d4Vv
    YJ2n028QPbTK0ZicZVkPBBHoRmvlLx94cm8KeLtS0iYHZBKTC5/jiPKN+KkfjkUAc9RRRQAUUVZ06zn1HUL
    Wys0MlzcyrDEg/iZiAB+ZoA95/Z38JFNBvvEdwGWS6Jtrc9P3akb2H1YY/wCAGvT3j8pSXYOVGBuPSum0bR
    bTQPD9hpFoP3FnAsIOAC5A5Y47k5J9zWBq8caysIx1oAz2u96lYckrwSemaom13StJEfnbqT3NXVgAGXUj2
    HSnKgVR9c0AZb2g3EuDz1zzmq8UKIXbALdFyOa1LzcqDaM5PQmqEodCwBUY5J6kCgCMnnLn8qk3bQSMHjAz
    UIUEFWPXpULqNu7ccAUAWYpgv1x1FXRKPKACh9w28/dPsawUwdqs7Hd1B4qaNljnyzqAhzweaAPL/iB4Lfw
    nePqNnJIdLuDn92P9S5/hPt6VyVvA906f2eryXJ5IXnNfTc39n6rpklpfDzradDG8fXI/xrwbUdGvPBXiCe
    2Em6yZS9vOw6r6H/aHSgDnbqBZYi5wlynDxEdfp71mOCjAr8p/Kuiu4vtuJoctctywHes0W2+Xyrj907Dgt
    0JoAWweK6ljS9LcHhs13fgDxeY7k6TqjYTOIHP+NecSI9nLtkBH8xU8I3yR+aTsByHWgD6KuIty5A3YGck8
    GqDRt3GBnnvXL/D3ximoH+y7+Ty504jdv4hXazW+1gdvPcj+tAFL5YxjLMOoHpVW7zeqYIjtfuR/Krl0DEC
    UwNvYcZqlpikl5uWJ7ZxigDCst9rqDwyKAQdpGM1v4x7A8gCs7VhG1+joCkmAT3zWo6loRJtO1gKAGBlIwX
    4ApQqtnIB+o603pgkEf0+tS7SQTnKjmgCJlwTgbgfbpTkLKcbfrk9adkFh706NQzAID1+tAFmIK44Az0BqP
    UbwafaFi2XI+X3qxCuw9senWuW8XXfmzGMN93pigDltUu3muXck7m9RissYUMFYKWGDipLk5YkAe+earBjn
    oc9s9qAIJE+Y4ye3Paotp6cgVZbkEgdfWmnaiHjcxoAgbg8dcVHKSeAO3pUrcdvxqCQ8HPWgCuQWOMf/AFq
    9X+DBeOK+x/q2wDzgcV5UgywHb0r2n4b2f2LRopWUeZOSy57DHBoA6q+/fXkDIrl1GQB3I7VzfiHVVGpQRm
    yLYYBmJq5q95c2ctvJFtaR8qG7D8K0tI03bCst1iSZjuIbkfhQBHcWoZVuLCRoX2/cxxUtheT5RL+J0fqpP
    b61rsAGGaNqyZUqCBxyaAJFA4Oc8cVIsmOuazlLWblWJMTdCR0q2h4ByDnofWgCaJQWY461UljOn3okQkRS
    cFeoFX4VO8sR1GPpTNTKtZyA4zjAz60ASbgRlSCMdaeFyAQeao6RIZbJQ3LLwa0Y1wMnnvmgCRFwec4qdUU
    qVI6imRKepA9KW4lW2Tc546DmgDCtlEOqxhSFAbHAri/2m/DQvNDsPEtuhM9kRa3JA6xMSUY/RyR/wMeldz
    ZGPUNRElsGKI3zhl2kGuk1zSINf0C/0m6x5N5C0JbAO0kcMM9wcEfSgD4Roqxf2k+n31zZ3aGO5t5GhlQ/w
    spII/MVXoAK9Y/Zr0H+1fiGmoSoTbaTC1ySRkeYflQH3ySw/wByvJ6+p/2bNHGm/DybUmVRPqlyzBh1MUfy
    KD/wLzPzoA9TvrwKH29q5O9leSYn1PIrUvyTk5PBya5a+vXW4ZIkwnZj3oAuidxxkc+venMzjsoH51mRXod
    kEoKkd8ZrU3jaGHzADnPegDKvZpRKmCMk1DcRSuGYvgZGRnrSXcrXGoQxq2zCljjqKllGZCHJHtnFAFZ7dl
    QNv4YHoTxVO4i+QqHwMckknNajKu0EFRxjGaqXio0R4LZOMdCaAKUcOY8qOcdenNEpCnIOOMkmry5PytgL1
    Peqd1hpVTAORjHbFAFzTbxkCbtqof4uoFLrekWfibQp7K7YeYR+7mUfMh7EetZU0gjgVYV2yEgDjnFWLCOc
    S4MrRsRyAOPzoA8k0+zvvD2u3GnalbIZoVyrHhXXswJ7U3Vo0vWB+bzAvykdj6fSvXfE+ixeJtEltHWKPVI
    lP2e4JySf7pPXBrxvw4Z7XXmsryB0uomKOpGSD06UAZrRGTi7DAjgseoqqQ9t+7f5kPI9DXZeLLaKOQXUbM
    x6PGR0965aa3d41lB3Qn7p9D6UAQ2SZuopIiylGzuXgivZvBni6DVozY3MmbyIYXPBf/69eM8pHmI+x9RTb
    J5YruKezZ47lTkFe1AH0HPILhTEInRzwNy9PelS3WMAKVOOCPWqHg/xPa+IIhb3cym/jQLkfKWrclt3iHzL
    wT160Ac5q6bp0+UbgO3FbEBC2UZYZIXjdVPW4NqxyL0DYPFaCAG2RB6d+aAKk8R4KnI9qhUAbgSemOasbGD
    bl49cnio5tpIYfLnqCKAK4BDdBtx0HersK/Nljz9arAhWHTk5xVyJcr+PU84oAkvJPJt5DxuPFecazcb5n3
    Etjoc9a7nXpzDanBHTArzfU5iS27154oAz5XyTjBNQjnhgMdM0pKscrnPpRITGAB1/SgBEwCQ3OO1Rs25vX
    60DgY/lT2AIyP1oAryDIIB/D2qrJz7dzg1akIHXFV8Bm2gHrQBo+F9Jk1fVoLWAZLuATjoO5/Kvd7+3h06K
    0ht8LFAoUY4P1rn/AIW+G/7Ns/7Tuh+
    +mX90DxhfX8a6nXY/Pt2I5Ze3rQBg686me0+bKM/B65rpLVyYVIPygYHeuUvEM1kjfckhOTnit3R7kPAgLc
    Edj3oA1pCSq4/GhRhvT6VGWI4BIxTyQB7+lADpQJFw4BHvUVkvlzmHJK/eFTxrkZPQUpGzDqAGHf2oAsDOT
    344qORN7qCvHWnxjeAecfWpVU5oAz7HaLmYDg57CtVASe2KqeWFkIAwScg+9W4DxzwRQBYUcZGODUV5DvVW
    KhtrbsGpozinkFvlwDnqTQA+JFCq6Db3OBWhCSCKpxDaQB0q9AuRyKAPlT9ovQ20v4gy3yoVt9UjW4UgYG8
    fK4+uQGP+9XltfVn7TWhLf/D+HVFRfP0u5Vi5PIikwjAf8C8v8q+U6AFALEADJPQCvuDw5YHQfCekaY2xTZ
    2kcb47sFG4/i2TXyL8MtK/tr4gaBYkKyPdo7hhkFEO9h/3ypr6+1i4V5DGmWYnJNAGdeTCQSjexDdh0xWNL
    AASVUKD6+lXXBS4BAwGGDUVwRtyMnHHJoAoXUKvGMPyPukcUi3YaIqQVPQHtmpJVTABkx9Bk1jXOI7tPLBO
    7PsMigBkW4atMY2OVQDIH9aurI7gyNnpzuNZ8Vyv9qT7CA7AZB7YrQmR1t8r1AznFAFmP50I3HlcnAxgGqb
    rhAGY7QfSrMWWOCxBIz1qTYVToc9c0AVVU7vkBJPoKp3w2ysWX5hzhulaalUAHTnrisa5ZhMW7s3U9TQBQS
    Vn1F2BHy44FbUDmS7kVf4ACSe9YYgMd+ZJjlX+XGMc9hW9H+7uQdoHmqO3f3oAWUlbhJIwBIwxkcA+xrI8S
    6DHrUK6rpoKaxHCy8EDzcdFJ9fSti6HzRtkMwz7ECm6LOUBBHzI5A3H3oA8V06/Z7h4LvzFuQ5R43HIPcYN
    XLuybS5CJCPs03IUqfl969R8V+ELfU7xddsE2alCuZEC5E6//Ffzryi71QatPcfapCgD4CMMEHpz70AY9zD
    ulZ7cHGeV7VHtEa+bCSH9PSteGzkIk3jZsHXoXHtVO7VGkOwbT0wO/vQBl29xPbXiXdtK0dyjZyK+gvBHie
    PW7OGC+eNb9FyyA5De/wBa8EngaF/MYEEdqihvrq2v0vLSUpNGcjB60AfSWswf6Odq5TjFVIJG8mNT6dqo+
    E/FC+IdFjN1G0d6BypPD47itia1MiB0G0Y9MCgCg4GcZIOeO9RSgPGc4PcEDGRmrJh2SAEEEdaYxC5BOPTn
    mgCtAGQnHGOPetG2KFMDj61VKFjht3XjNXIUEeSSSTwT3oA5zxgzKBsBGBkk/wA8151cvyxzjqfXmvSvF6b
    7YN3x0HWvM7lQszIzfd79qAIN2MEdSOuKCcr6DrTMFTgt+FORg2BtIHpQAmMcNwf5UHGGI5wOoob5jnvTJS
    EBz8ufUigCKQ7m+Yk8Y5rpfAfhubWtVjBT/RUO6RuwHp9a52xjjur2OIyxrlsAk8V9B+BodLg0trLSJvPki
    w0zhCMk/WgDXZVhQIg2xoAAM8AVTkVTuDHKnjGKsXTP2Bqtxzuzn0oA5WZymo3EDkeUehI71FDfiziDKjSI
    GIyvJFP8ZukLqyABpBkkiotNszHpYlkLHec7V70AdbptzHfwKyEgkZIq6qbe4rldGuyJVZYjFEOxrqlIdcj
    kHv1oAkVsEVIOQB+FQOfTmnxswx6e9AFmFQvyr0FWEPBz09KgQggc1MD8vt2OaAEkQEZxyKmjXnnnNRhRjH
    XNSIwLYB5FAEwHTggfSnrn8KYoO4nHBqdVyRQA+IHcBnmr8HQYqomc1ahGAM0AR+KtIGv+D9Z0ngPd2kkSZ
    5w5U7T+DYr4GIIJBBBHBBr9ELRtpUg9DXwz8VNJ/sT4jeIrABVRLx3jCjACOd6jH+6woA6b9nWxNz8QGudp
    P2KzllB5Ay2I8Z+jn8q+iFUtJKzEcnBrxz9mO2wviO9IHSCBTn1LsRj8Fr2GZ1jLkMAM5xQBDdArIm0CoJr
    UlSRjnmm3N3uwAQCPU1narqTQWUjK4zjoTQBC0gklJQjAO0j271V1VlDouwAocg1Usp91quCASew60y8nVi
    qFtznkg9qAMx5WS4a5jUAg5w1dFFcJLp28cgjkbuOneufuV3K23BH1zT7a6khjCLjIGcEcCgDoEClY2yMFe
    gp/zsMMWAHB+bHFZuk3ANojMf3xyq55AGanabaxG4nNAEs08cAZYQAfXPJ/GqzKZUDfdPUYzR5RMxGAO4BN
    WHyijopH6mgCm8QYyAoFOcg4qVG3ukmcBOB9e9RrKd7fITkY2k4qNwIUA3D5sk/WgC4rK+92XHpVbTnbz3Q
    r0JOO9Ri6KDl12sQRk81DZS7jI5ygY5+UcmgDrbO42xqWYjHTArh/iL4Ci1O5TX9GjVbpWzd26jb5oHVh7+
    vrXRWrogXBwRyR0rb0263EhCCnTk5oA8M16/huWNrAYlaEAEoeAfSsBE86XbGMPnqfWvSPin8P5ZpX1zw7F
    +
    +63Nsg+/8A7QH8xXMX1jFZ6PBcQ7xcOmW38Z9SO9AGLLtkUxzACReoPXFZd/p7WzK6/vIG5DAcVdebz2+U/
    vx3A6j1q9Z3KQo0Fxho5Vw2f4T60Ac+NVvLWeGS2nZGiO5QDx9MV714B8WW3inT0ilTZfxrh07H6V4frGiy
    2QEq/NC/IbHUUafr95pdqsNi4jYOHD45yPegD6QvLVmRvlUdvTFZLQyRld/zD1NVPh/4xtfFFittct5epxj
    50J+97iumurYEbTkDHAxmgDGT5iehzwfarEcfTJ5PpQYcN2OO2M0cqOB16AmgCrqsR8syQJ5kyjAGM4PqK8
    k1qzkgvJfNP3mz616pE729ndfaAd4yOAePxrz7V2D+ZllPPBzzQBzRRQOuefTj/GhvlHGfeiQMCSDxn9KZv
    +U7uPXHFACF/l4xn2NQuiyn5gGxRnJJz+FdD4F0ZtY8RW8cqlrWMiSU9BtHb8aAPTPhp4dttH0Rb+6to/td
    yA+XQEqvYc9K7SKYvH8q7R6Dism9u4w/myTKlpGMFsYCVfiZAilCCDyDngj1oAZIm6RueQM1A7MZBHGpBHJ
    Y9BVo5JDDsaYqq0cjgYbkk0Aef6vb3GoaoI3Vid2FBPHWus05I5bcQSKFkj+X2NZHh9Dca7NJIMrFkjHr2r
    pjApk6ZV+vqKAM5rXymPPA6YPNaVqFKKRmqGpW08JDxMXB42E8U7Sr9cNHKCjA+nFAGoMkn16VInr0pF2su
    5SCPXNPUFSOgxQBIo2n2q1Cw+hFV42yBkc1IBkcZoAs9eOKdGgB4x+NRoSoAP6VOuQV4xQBImc47danT3qB
    c1Mmcc44oAlRsnA4FWYCcn0qooPbGatQAgcigDTtzyK+Uf2pNOFn8S1ukRgt9ZRTMxzgsuYz+iL09a+qIW5
    HP5V4H+11ZceF79V7T27tn02Mox+Lc0AR/s8NDZeB9SuZVVXmvioPdgsa4H4Fj+ddhd33nSMNp/A1xHwZt2
    j8BRvuyJbmVwMfd6Lj/wAdrsLm3fhlf64oAZvG8Dcq59Rkj2pusxpcWpt9owy81EFYyhepzxirF2juBkcYx
    xQBy4Se1KoH/c9AT3qcqnkSZy7nAyecVburQ/ZyWJBB4qvasqkrI3GemO/vQAssBW0GASTjAJqukRMDOCBz
    j6VevZ47aNWictzymM1kGe4YExIpVuTk84+lAG1pSL5ZVeVHOfepJy0bZXADdKrWKyCEkMBkfd9KlSPbJvk
    JbPt0oAkSRAjCU7gRyPWmvNkHdghRnpTQqPIx3MT2B4FDAuuMjgjvmgCGOZCpzuz9KuJ5c8HlqmQepI6+9Z
    8yN95nHJ6jj8q1tFwVLYDY6Hrj/wCvQBnX2mRowkBZW9zjim7gSqouHxjIrbulMinYNrDu3P6VQNmxYMoyq
    jBJzQA+GN2QEhc+gHStXS08smQsSenPesaXzotu1yoJ5U4Iq7a3LDhyQwGMGgDpILlTwuDXl/xS8E3Eudb8
    ObzIiEz2g5BX1Uf0ruraZVx82QOMk8VrWk6859ORQB836bpM82lHVYQQFzuBUgiqlzPHIBJlQ54KAdK9i+J
    fhzUTpUl54YbaqnfPZKOHHcqP6V4jaQPeu00CEup+dO4NAGvpl8r27QXzZi2kRk/wmsi90mSXMkYC/wCz6/
    SrEqKyBxgKvVQeR9avWNy92nlM2fLGVz1NAGf4d1caE07eSv2sj91N3Q17N4A8aweJrYWt2wi1NBhk7P7iv
    Hb+zW+lMcahZR/EB1NVtCf+ydaR7zzIpoiSrA4we3PpQB9IT27gk4wB601bfcCXHp0Nc/4A8bW/iJWsrtxH
    qUfAzwJR2Irq72QQIQvMnY0AYuuKywGNMBmHPtXnGqQvvKFvbntXc6nIzRszOQ7EHJya5+8gQwGaTOM/L70
    AcTcw9VIBI4rHuchyOQM9xXS36KpJHX1Nc7cxMZDnHJoAm0KzfUtVt7SLJaRwoz9a+gLbT7Pw5pxS2hRAcA
    kDBZvUmvMfhHo7za8L5wPJthu57k9BXquvwG7iRACRuzwaAOH8a251yzTSI5Wg3srlo+7E4UH1HU103g/Rm
    8PaTHYNdyXZUk736D0AB6CoLPRzHqrXks29B8yR7eQ2MZJ9hW4r46A5oAsuQEAxzVC6ZoILgRD52BK/WrZI
    K/exVe7byoS3fpwKAIPD1kYLEu4Xz5mLs3t2rTHGc9vxotv9WisOQPSpWTGBQBDIu9SvP5VmGJVmLPGMfSt
    XBXINV7qMBe+e+OtAENrA1s5kRyyvyVz0rRjkGQG+VvcVDD88RVhnjGc1LEW5R1wF6N3NAExwo4IqWPg+1N
    iVQPlAI9TUsWcn09MUASgAjp0qSNsHGPlpiHgZ/Knhc4IoAspzg1IB04qshOe+e/pVpTuPGM96AHgDqM1ND
    npUIBFSx8AE9aAL1vnOa8j/AGrbUS+ANLuRGC8Gohd/dVaN8j8Sq/lXrkJycd684/aWtTc/Ce5lD7Ra3kEp
    BGd2SUx/4/n8KAOQ+DsQPw309icZmm6d/nNdfLEBGRnJ9cVyfwYI/wCFcWHJ/wBbN/6Ga7JEJzuGfagChFE
    RJ0JNMvm2KsQTNaIUKxJxn1rD1aZ1mUDGGPPtQBm6nciACPdyeSDziqtmhkiVApBJzyOtUpJC+ou7HKrkAs
    a0LaaEQph1wPfPNAFy7tCsJ2uCvQgdayb62ZHgUYySADXTB4jANzDHqKwtRmiN/ZRxqWZWLZPOeKANSKAeS
    AWwPU057VWhBBbAPU0kU5dM7SBihJlbdvPAPHbNACJDGXKdB3Of61A0EZG35gvcg8n2qxNIolPl5x2OKozT
    tuXjAB4J7mgCT7JnLLv2kcBj0q3p6GJZCDt3csRUSO0g+VQx9fT2p0rSxEgDIxuGAeKALMpMbhjl88ikS58
    1CgABXtWbe3FwYlJwMEE7R0FRIHEiMZQxBAxnGPw70AaU21gDvAPfnnNQzfwsrcjqOuasiBfL5AAPIwKb5M
    ZjDIOVBPSgCW3Y7Q35Z4xVmG5IfJPtTYodkS9DxnmmKg8xs5wOlAG9YXGWU5OD1rmPGHh2bTrHUdU8LWcDX
    U6k3EIQZcdyvv7VoeayEYfpx9a3dOujKq89uM96APlB2e4neREKtnEkXoe9XFXyo1lt2yCOfb/69e5+K/BV
    gt/L4g0+xEt0EJltlPE3HXHrXgep3Ykv5ZYYvKJYh4MY2n0xQB0UMS3duJLNT5gHzAUzUIodRs0tJEC3CcR
    ydx7Gs3SbubT5Fu4X+Rhhtvb2xWzqVuJoEu4Jd8kgySnSgDlrRZdP1SJLh5LeSN8iROor1rSPHlveFrG+kH
    2hAPLlOP3g9/evMLtkuoRHcAi4XhX/AKVjiN4rhRJlWByCD0oA9+WCa5cFgwDHn3FRazbQjG5sL2HrWN4Y8
    YRx29vY3zq0zINk3ZvY+9aF4ZbubEe6R3OFABNAHLarGd+eq/yrNsNHu9UvVhs4GkLfeIHAHr7V6ZZeDWlj
    36iwQHB2Dr9M10tlZ22mweVaRrGpPPqfrQBX8M6XHoulx2sZDMPmduOTV+Z+pBIpGBzgHrURBJ45OcUAA6t
    x26Zp6rkDHI79qRV46fXNSIoBHTPfPagByRkkcfl0FOurfdZzYYodhw45K+
    +KmjAAA5zUjuwG35eeBxQB5f8A2nqt5aNBb6pb3pVvlaF/IuFx7Hg1peHvFOtxJJHqul3N3BCB5kyx7JEHu
    Oh/Cuqv9D0zUFKXmnwS99+3DfmOaj0XQF0q+WS01C9FsM5tnfeh/PmgDYtXhvbWO5gLCORQy7htIB9qimTC
    sB19a0OoxgY9hUUyqEJKg8fnQBl2jES
    YIwM4HtWpsyOeazbfLXGB61qouAOM5oAiEeMkVJHgHP5CnBe5wTT0TuCMUAKM8elSp79KaoOalVT3xQAo7c
    fWn9DxQgyRk09QN2AMn2oAljO4c9TUyjB5NVBvz1xj0qxARn1Oe9AF+Dqc1wn7RWB8HtX/AOutv/6NWu8gI
    xXB/tFZPwg1c/8ATW3/APRq0AcP8DCLv4dRIF2mC6liJzndnDZ/8ex+Fd01u0S5zx6V59+zjMX8G38RZSI7
    5iF7gFE6/lXqs3oFz70AYNw+0KD39qyNUQSeWzEKFPJP6VuXMeZyT06dKoaxEr27MoG4DII70AcpqqwLc4w
    GDAFe2ahtZIiGiAUYPTFXZbLmF3+c7ur9TkUi2AxujUrt6beMe1AGzaQxvZ7s/Mo49qwr+3/4mFuzcEk1r6
    RdfeiYAMRxnqarzruu7eQZ2buSev5UAS2YBZ0ChmBwM9qvywRpF8yIxJ9O9V4tguWB3HGMnGCKsSODl8YUj
    GM9aAM94t02D1zjgcVMYVVDtUevT9aAytLtGT05C4H51LLHt4UkA9N3agCIBQoA4A5PPemvOP3nPb9Papy+
    yBtgLdsnjn1qhI4VHLY2gcn1GKAKCo92so3Mqo3QdCfU+tTBC1ogAUtjn1Bp2m4aGYj7pPHvxV/Tl/0dhhQ
    QTwRn8KAK+l3BZWSblwfugYFaGmRec77z8q8Yxwax7+38sTnKqCA6Y7H6+laPh+4dYmVgTjgZ4zQBsTqABg
    dsY6VQlxzjIb/P6VohwwPQn07VQlKpKSBzQBWbJOM98dK0tPco2Acc9c1UO3PKkE8+tOiYxuMnC57dKANtJ
    GJ3du4rzz4i+B7TUriLV7ILBdK374KOJV6k49f513iP8oweP51W1GVx9kEahn875QemcHr+tAHzlq726Xsi
    2Cusakq8TjBPvinaRqL2sq9DbE/cPb3r1rxl4Cg8Rqb7TG8i/TJeZhgTH0/+vXkviK0j0yUW0Jb7QoAmQjo
    fagC3qVosoN0jDc3IQfzrHJ+1MqMDvXgHFLYag6gRMSYz+lXZLMSAyRtluuFoAxJkkVgHZgFPHtXsnwl8V2
    gjistVwtwx2RXD9H9F+teffZlvE2ynZIoB59KxL+5e2dorZsRg9M9D60AfWU6lhkZAxVDKs3yMGIPY9K8c+
    GPxNksp00rxPMZLN/ljuW5aL2J9K9lt7K2hQz2cvmRSfMCDkEHnIoAaRnAxx606OMu2QD+FXIYN8Qx+fpRK
    627hFwXbnHoKAM+7kS3wznaPQ1LC6yqHTDA9+lcV4r1sS3rJFICqnBK9D+Nbngy/huoPswfdMOSPagDoFyA
    c9KcMDAxgfWpWi9qhOQR1xnigByj5znkDjNOQkn5fXoKOoBzwTT4120AXIsFO/TFQ3aZhf17YqaIjGOce9E
    i5Qj2oAw9Ljka5Hm4yM1s7SO5qlbqEusgYGMYq8OSeTQAgGcD+lSoMD9KTjOOc09M4x1oAdnAA6YpwwDkVG
    CBn+tPU56UAPGM85xUiDJ4H4UxV3YBzUyArmgBCCAf5VLBgGmE5NSxKSRxQBdgbPB/OvOv2lbsW3wmuYim4
    3N3BDnP3cEvn3+5j8a9FiGDwOleR/tU3LJ8PdOhDKPN1JMqcZIWOT+pFAHHfsv3GR4htSUyPImA/iP3wfwG
    R+de6vESCQBjvXzP+zdf/AGXx/LbM+FvLOSMKWwGZSrjjucK3619MyyMSVQYFAHP6wghQsD0PAHes9beT7M
    DJlu5rZ1eLd5KY+83PPpThCPsz564IFAHKXQH2eTcygqRjHYVVEYRwpDAFs7jWncxlYCGAye4qJLcSxuGTM
    hGBigDMvgsV1CynnOCGPWql491GIXEQZQ284OMVuXMAFi7kbCpGD3zVaQxyZVjhBxgUAIm/zCcBWJB+tWLb
    bdXDwncUHJwarA4YDaPYk5NX9JUC5mfrlgMHmgC48EZQfuwq1W+xsQuGIRf4TWm6EorNjiq7yoik/ebpgGg
    DNvY2SPIXKZ6VhXLuUlDAgHpjmt6UmZSBg4P5fSo1tFCpkYP9KAMnR8PG6ICCVHLHFbemWpSEcEkHrmq9nb
    C2vnY5w2QMCtaJPlJUgjHzc8UAY2twoHJ9fl9aZorL9odGG1iCR2/StG/jV4nGDvIODWLYMqyJNGRuB5P6U
    AdQY8DOOtULhVEnXIPp0PtWikitHuHSqN1gZ2YLds0AViTuBUjGOOeaa+0ldoPpjNO5ZT1JJPT+VIkfIJJz
    7dqAL1s5KqGPOfpVfVHBe2DnC7zuAHOMdB+lPgbbKoIAHck0zUlYXVmV5bc23jOOOSfwoA07aTAXzlzNj5I
    1OFA968r+KeipqupPcQsPtYwAVHX2P+NegXt19lsw8SmJO8zdWNee388hiKNkKz7y7cMaAPNrmxa2iKykpd
    ry0eOo9RT9E1JrefEnKE8112r6bFqVsuAI5VHyy4IZvauIurSW1neO6ASde3rQB23iS1tjpMNxa3AMsi58t
    f4q4d4tykkZkq1aapIsgMg3tjaAegH+NLKVkZniQlhyTQBjT2+w5cDPceldn8P/AIiX3hopZXm650ot90/e
    iHqv+FcvLGzklsZzVfyGd8KuaAPrNNctIfDq6xYSLc2sgzlOQB/Q15rr/iu5unk+zkxq/Vgecf0rgfBniO7
    8MylJJN2lTtsmgfJUg9SB64rp76GzvIWvNFnFzZbsEjhk9mFAFZLjJ+bL8Z5rqfAUyjXrdQSobIHPtXF7ir
    Ae3Gelb3hWQDW7M5CqrgsewFAHt+3A5qqy/jV6TbgEDrjFVmAwT19KAK/QipFOe+0UrLgdM+mKaOGIPbrmg
    CxGcH0/lVhlyATmqqc5yeOvWrincgxg0AZcqeXcgjpnvWgOlQX0eV3Y4FS2zbolxg44waAFPUUo4wMHPpTm
    GCAo6dTSgYHSgAAyfmNPwD1oAHOaOgoAlTtzxU2Cy89PrVdR0yBirQOBQBHjDdParUXSmRjnkfSrESZOQPz
    oAnjwAK8A/a1vBs8MWSshP+kTMv8AEPuKPwPzflX0FEoyOBXyp+1HqH2r4jQ2iyblsrGOMqGyFZiznjsSGX
    9KAOH+F+pDSfiDoN2zBYxdJG7E4AR/kYn8GNfZc6hQwA5z6V8GozI6uhIZTkEdjX3DoWqrrXh7TtUXgXlvH
    NgHoSoJH4HI/CgCveK0kyg8EdqtLB5aDfzmo/vzFsEc1aQkkbv1oAxNfhWGxaQYA/rWfZMCiHjJXnFa/iuM
    3GmG3QkHO4sB0rkLa5NsY/P3HGQMDOaANa6i3QKmPvHkVmSBSRwMrnk9a142+0OshXC44FZN9ZyG5Zwr+W/
    UDtQBk3N2UjZcHdn+L/PSrmjajsn2SnJcbxn/AAqpqdsIpEWNfm5AJ5zmn6baR2oLyMZrg8ZPYew9KAOkkv
    TKpEanZ03VnGRpDINoOe5zU7ShYegOeiqKqw7y5JDEN3IxkelAFmzQLtPc9RjpVs4yAx4IxnNVVdwrADPsD
    RG77ctHgg9c0AQzlmJClQ1TR3BRNj5R8dQDg1VuJH3bUj5JOGzjFDOxXac4bjK80AN1LUAp2RHfI4KgA1Xt
    4Cq43Ebh0NXYbZAWMi/vCe/OKmaM5UngYxkUAPspPs7CNiCPX+lWpYvMU4GB78VUjjAIVwD3xjvVm1lbLqw
    +6cLQBVMJGVzyaREKhVx9atyqc5GOTznvSouDzkigCFkVh0HPTjvUN1lrm1DAsoDAp/ePGKvBcn0+tZN3K0
    F8Xkfy0EZAfHIBPQe5oA054I7mNknCTTAdQPljz6V5j4ng+yPu8zzipwMcBTn0rvLFZFzNLIIIyvyL2b6n3
    rhNfWSe8kjk/dMeiL0NAGXHPvCMCXlYhQ/8Ketad94es9a8PsSii7Eu2KbPI9yfQ1DosDo0cPl4YH/UsB8x
    9/auiso5BDKpUkyykOF4VeOgoA8W8RaPqHh++
    +yanA0cjDdG/wDDIvqDVeyuPLJVgeTyM9a+rfEPhPTfFfhWKwvogJVizDKOWibHUH+lfLni7w5qPhXVHstU
    ix1Mcq/dkX1BoAuJbJdPhSEB5YnooqG5hWPKoOBxuHGR6j2qno98LeYGXkHrmtjVpY5QJ4MBDwBQBizP54E
    cjcDhfSrmiT6pouoCazQ4I+ZGHyyL6EVJp+mHUPMaMgMBkAjqa3tELrcQpeqCFbhn6gjoKAN/7PY6pYDUNN
    kZJQAZ7Uj5om7/AIU2wvvsP/Hsqh+74yf1rsdE0fT5Ym1T7JNFe7SCE4WUY/I1xEkMVxcNc6cymFZCrp3ib
    0PtQB7l4Zuzf6Jbu5zJtAcn1q9KoHA4PrWJ4BspbPRQ8rE+ZyB6Ct2QgknPSgCuyDuKiVTyOeD6VOeTyMD3
    pdmTk8GgBiEEc4xVpPuAYyfaodp6d6mUYUdTQApQPGynvVKF/Il2NnaelXs479ajuoPMUMPvDpQBLjI6inY
    9+lZ6XZjVVbqDg/StBWBUe9AACMcUmN3sKXaT0XAqUL1J60ACqAASc1OhBIAGSajCg4xVhRyBn8qAJAvoKs
    QLnuBUC9atxLgDPU0ASqgyAOa+HPizqo1r4keIb1WDIbt4kYHIKJ8ikfgor7R8S6suheG9U1VwCtlayTgZx
    uZVJA/E4H418ByO0js7ks7Ekk9zQA2vqL9nnV/7T+H5sWbM2m3DRYJydj/Op/MsPwr5dr1v9mvXBp/jmXTJ
    n2wapCUA7GVMsv6bx9SKAPpD7PsBPOKcGCxcj5q0Ziuwgr9ayJzkgDgE9KAK18CyYB5J71y9zYiC6Eg5Vyc
    +xrs2h3xjfjArL1aDFq3lrluv0oAy/tCRRqiLuboT6Ub3aPaqg5HJPSs9FfzsOwVePxrVjKkEgjaOM0AZl3
    ZrsMjAh8cEVl6PcJLCzDoW25buK09dl2WjKDtd89+cVnaDCEtrL5AFbJIxzmgDXSIgZB4HXHGfanqCxyRx/
    KrgQLlgQM9qh2jcQ3U+lAFZgRnAAB5zTGDAEnBHrjmrLqoHcHP1xRGob5cdDzQBnTFjuwoz2Jq1ptoohBkY
    njipLmMiPanf09Kms/kgVDwRx9aAEaFVAOATj0qHadw28Ae1Xyu4bSOKheFi2AcKfegCrkqOevbjNWIIBHH
    z95uT/hT4o1j5wCfU9qmC/KaAK5HHIyfakUDcDkkD07VMVA4P+NNRTuJ7UAJkk8Zz6Yrnb/MlxIjHMmwlMn
    jGev1rpwvqM1xuuTo+vS2wdlWCFZHUDBcMT931IxQBLdahF/ZKwhvMdm+aAnDL/hXL3FwkcpbZ5jcgKRllq
    K880rIA5UsD5eDmQntmsXTbeSwsBHdykybyeTubFAGrYefPdBYHI3NlpcfMldIZGgiaJojlH4RTnHA5P86i
    8LJA2nzzxhY7reEXPO4e9P06Jrv5tPEr/wCktG5bodp+YfnQB6jpblbOBVBA2AjP0qDxT4b0zxXpbWWqwhh
    1jk6MjeoNWY+EGe3FPWXYQTj0FAHy18SvA1/4MvI1lzcae4/dXKJhc/3W965G0uGLKjklc9Ca+0tTsrXWtO
    nsdQiE1tKhRlb3r5j8cfDu98H3zvJ/pGlu37q5Xt/ssOx96AH+GVa1vobonEAYbSRw3qK9Q8R6CviGzg1LQ
    oNrRKDIo4GB3NeL2GtXEhWygTemcE/5717n8KfEsVjbrp04CpOTgt/Ex4oA6HRbuy1PwebNNq6lEuwgj7re
    uPSvHbqxi8PeI54WEiGXmZmPyvnv9K7TxXcxeCPE39pL5k0EpyYk/iB7fhWL4jun8YTW09zAltIT5aRg5Xa
    fukn15oA7Twr4yjujYaedrow2RyqeGArt3jJPI9+leOeGvDreF9RhtNSuQ4WQSRMo+Vdx+7mvZ2YdBg5xQB
    WK4PAJNKq7evSlfdk81H09aAJsc4p4GBUcIxjg1KxxQAwZzn0qWPp1/KoycnnsaVD0GKAMfxW0Fnp8ly4IZ
    OcDq3tTvC+oyahbDzYvLIHAPXFad1bx3cJjlUFeozzzWfp9k9lfhydyEYGOgFAG5t5p3b2oJyOaAP8A61AD
    k4PHSn4xjv8ASmjjoKemc0AWIxk1aVcD2qGAdatAZ4NAHkn7S+u/2b8Ov7PRiJ9UuFhwDg+WnzsfpkIP+BV
    8lV7F+09rw1Lx5FpUTZg0qARkf9NXw7/psH1U147QAVc0i/m0rVrLULUgT2kyTx5/vKwI/lVOigD7vsNUg1
    jQ7XU7Lm3vIVnjz1AYZwfcdPqKgtbcu4Zu1eT/ALOPib7d4bu9AuHBm09/NhBPJhc8gD/Zb/0MV7MpWOEHo
    T2oAWVQ0RP3cd6x7/BXaDnPf2qzdXjCPaB16Cs+SZFDNKRwMAUAY11CRKvrnseM0CIxxFioZic//Xov7hgc
    Qxg4GTuNMET3MB86RxtGRg4oAxtfDx2k0qncWUjOc1JZnC2cccpBVByB046VJrEQOnNv6Ej69asW8e5oxGw
    I29cdaANaP7oUgk02UYycZHfBqTcPL+YYIHaoZpAqZ9eKAI3QOTnGcdM80wLKFKoRj1qcEcNnOPemecoBy6
    0ABjbaMufwpjMytwVz15p/nRiPKndVOa4Xr+uOlAFh7iUIGyqjGTTYbmUqSyhyPT0rIfUcQSko7AHG1BxVm
    xlneVGMaLG4BALZxQBove+Wfmjbb6jmrcTJJHvjbI9qhmicqOBz196rRoYmLIyoc8gd/wAKANHHHP4UwA7s
    5/HFPXOMge1IM5780ATRDIBHXpXn/jGJ7XU7vUAqoyxrGLjPK+1ehRgk5/CuR8WxCWDU2YF2RQwJPyjHY+9
    AHl7X3mXTyE7CB8xJ5rHLz3etQSJcMtovDEnP1470TSgI7OMM5+V8dRmrnhiyN1qSCcCNem88qRQB6voFlF
    HYtHplt5lthWkuJOGkPU4rY8G6cLG2cjBty7PFnk/Mckk+9P0mHydJJwd7Dhm4UD2rZ04FLGEfKCRngcdaA
    J/NAHHP1qMyLknODSuMY3H65qByrDtmgC5ay5cLnJ9qseJvDkev+G57RlyzjIyM81Hplm24Pxz2NdVayCBF
    835R0oA+MfFfhi78N65JAo2zRHzFQDkL6j1qa116a6XzJT5IYjBXjDjv+Ne4ftAWttfaGbq3h3X1r+8SRRz
    jPIPtivnvw5pC6jrBgnufLD8hm6E9uKAPZtOaDxV4QaW8/eX1oOVz1A70nhjSItZgkikyslu3CoONvY1Q8D
    Xceia5DC3zx3CmGTC5wwpl5rd94c8YSw29pI8cgK9cAgnigDO8ceKozq9rYSMruGMTOONpHGc/XFey+Fbk3
    /hywuC4kYxhWb1I4NfPvxF1DytfbfbQNEVD/u+zd+a9v+FcwuvCsDZH94Ae/NAHTyJx7VCVOOBVydeOP/11
    CnXJoARBgfN/
    +qmsTk4PHarCLuHT6CopkCNkUAR8jOfzpQdx9vpTTkn2pyjgE9qAHjkVMuCKhH8qkA4yBQA8MMjA7dalC8Z
    NQIx3YqYscEf1oAeBx71JGoPFRocscEVbjXIGO1AE0KevWmaxqdvoui32qXxItrOF55MdSFGcD3PQe5qxCB
    kV4t+1L4oGneGbTw7bSL9o1J/NnAPKwoeAf958f98GgD5m1jUJtW1e91G6INxdzvPJjpuZix/U1ToooAKKK
    KAOm+HHiQ+FPGGn6ocm3VvLuFH8UTcN+IHI9wK+wbu5jkUSQyK8TqCjKchgRkEfhXwxX0d8DPFK6x4X/sa8
    lze6YMJk8vAT8v8A3yTt+m2gD0fULlo0AiC+Zt4zzisaK3kMRaaaSSVvvNnFWL6by7raQTuGcGqcNyWLDBB
    JwAe1AEN3b4CRh5CmcsAat21sqq3zuQeu41WuEuWmY5HlDtmtKzIKgj5mz3NAHNeJy32Pao+TcOv1qS1uZT
    PEkY3Hlc46cVc8SWBv7YQqx+ZsnHHSl0y1WCAAJk8A80AWSsxUbg3I9ar3EUjlVYsoz/exV263NNbwQjlyc
    nPQVoJZR42uNx6GgDIgtmKLlsjpz3qSKzXcckbvpVtrURH5GI56U4Kw425A68UAV5LdFTjjjr0qnMAu7Lf4
    D3q7c8PyeOOM1nXRbeEySWxnigDMRcwrkMFZiCx6kZ5q9ZqRAPmK44HvUt1CEgjVf7vOOKu20Cm3QlcHHTO
    aACG9RoyjHMg6/hT4lUtxyzNVeWLYMqACODx1FW9LPmK7Yxg0AXZskAcYqH5e5/8Ar1MwG3AFRdOMdqAHoC
    T1bBrlvEEqhNV3oZeNohX1xwa6tCVHp9RXn3icXLSTsknlwecWYqfncdMe1AHml4rTaqsMcTHa2Cijha9S8
    G6RFI0TSQJNCnLREcrisfwvZwya2rPbskeCY5PU+pr0S2RIdxLFWc5DjjdQBc1VFaIgZdAhAiXgAVctU22c
    KjsgFZNzNm1VsCJicAA8sfet7aViUHjAAAoArSgEc0y1j8yUED5QafIMnAzmtazttoGRQBYsk2qMir9zZ/b
    bQxbih6gjtUUMWcY/StGIGONm2ngZ6UAeT+Jbi4sdQntrkxzSNE2wHo2O1eMarqmnotlqEVnLbTiUl+gB5w
    QPxr3vXLH/AISS8hEQxJHMDvA5AzzXiHxO0mO11/VtOaGVWt5s27bvl2EA9PXJNAG5qM9nFNBe2qyPvCTjc
    cDPetT4l373lrZXMEMcSzRqS6jnP1rB0PTls9CiN4dytERGC3frmu51a6tJfh1YTR2yF4mCbmI4oA85udBl
    tYDcS2/2lLlChLgjbkdc17R8M/s3/CG6f9iIZFjCFsfeK8GuR+IwkvfAVtPMzQwIAuIeA2fWtn4FWckPg5b
    dH3orsybuuCf8aAO4m4Gck5qNR3x+VabwOow0e71IqhIQrEYKt70AIrhe3FJN+8TPH0puCcihlKITzzQBDg
    56cU7OTjmk6inIuCCeDQBMsR28dafHCx6g/SprXDZ9qsHHYdKAKhgHTn2qNgVOD9M1dZgRgn6VFtBJHXPrQ
    A2BOcjr6VdhHPtVePAOOhq7AM4oAlVo4Y3mmZY4kUu7ucBVAySfYCvhz4o+Km8ZeN9S1cbhbO/lWyH+GFeF
    +hI+Y+7Gvob9pXxkuheEhoNnLt1HVhtkAPKWwPzH/gRG33G70r5NoAKKKKACiiigArb8Ga/P4Z8R2eqW+SI
    nxLGP+WkZ+8v4j9cHtWJRQB9eTTw6jHaanp7GWCZBJHJngqRnp6/1pbZFVizNnLZOPWvKPgN4uVJh4Y1KQC
    OQl7Fzxhzy0f49R75HORXrsttJFeggHYTkigBxjHmseoPSmufs/KjAJx1xWhDCNrAtxVO/tSfLxk/N1NAEc
    WHuT7jP0pHAiuAuAQfyFMjmW13ZDcfnRFOk8vmZ5IwooAsWal755W/gAVeelaLgbd5OfXmsyJys+5T8pOMm
    tCN9wYN+FAEZ+8cDv1FSMAykscH1p8uFXk4HvVO4mLMFjIANAFHUGy3ynHoRWW+ftCswYk8ADnNbrwFjjaO
    lU7mAKysAeODQATQGWJQy8YBxmrkCh0A47dqkVcIpzkY7UIgQHjGfzoAryptDBzke3pTdDGVkABADYGatXg
    wFDH6VQ0jctxcxgjkhue9AGu+eBUZ+8ASPWpWUlec8U0quM45FACbecg5PrXnmsXDwvcvCokk8479w4Tnt9
    a9EAJUnpgfnXLBIpoAJUBIZniVBjcMnlqAINDiDzIyja4PzRsc59fwrorgqj4ix5bfeU/w1zXh6dnlkErhm
    Vj5br0A9K6aWMsqswHndQw6GgDhvFPiPxHpnmf2P4ba7i3YFw0vm7j2xGuGryzxH8SfGV9LJBeahPYDoYbd
    PIK/iPm/M19CPgaparIf3pcEKBwPUfWt6/wBHsdbjEN/ZW93H6TRBwPz6UAeceFvEXjA+HtIFv4Na9iW0h2
    3DatEpmGwYcgjIJ64PPNdvpuuePpGj/wCLbEoSAX/ty34HrjFdVp2jx6fYwwW8Ijt4UWONVHCqBgD8hXSaD
    MVJhP3T09qALKWqxDMgCqOpqO9urRLaRFdGcrjg1o3UZmt3jHVhXm3iJX06ZymcjqPWgDHbVb
    jRNUEccfmQzyfKw5Kk14v8StRlbW9f2y+aDNxKF3hRgAjPbBr37QksX0251jUyMRfKin+8eOPfNeW6l4Flt
    NUkQOXstSnLeX1ZVzuOfXmgDL0ZIbvwlCrTebJEjMWxxjoK0dVsVl+FW1p1QLcBgQcHg9K73S/C+maHoF/t
    iRiypCM9R3OKt694asZPAFvbRsFaWYMAfbmgDyrQjJrXhMaMguJgGaUjd1Femfs76PcxeF72S63orXboiSc
    lVXjH5g0+wj0rwbpEMsiW8LpEWd2PUGvRvBkq3Wgw3MQCpP8AvVAGODyKALc1sqD5RWXc2kbkgLW7Ohx04q
    qYwBwKAOZlthbhiBmqUsnmKBjAFdDfRqVPTiubk/dyspoAVBweM59acRUav2HenbieKALdudq54qZzkDHSq
    sDENg4xVk8pxxmgBpJznFPjXI60gT0/GpFGOlAD1jB5Jp17eW2laZc39/KILO1jaaWQ/wAKgZP1+lSxRE9c
    8187ftMePfOmPg/S5QYYWV9QdT95xysX0Xgn3wONpoA8h+IPim68ZeLb/WbssBK+2CM/8sohwifgOvqST3r
    nKKKACiiigAooooAKKKKAJIZZIJklhdo5UYOjqcFSOQQfWvqn4Z+LofGWhJPKQuqWwEd5EB1PaQezY/A5Hp
    XylW34P8R3nhbXrfU7E5aM7ZIycCWM/eQ/X17HB7UAfY6xAoTjB71WuBmZFHpk03RNasda8P2+rabL5lrOu
    VJGCpHBUj1ByKRZWd2l2n5jgA+lAFbULMHmPGWGMmsd7AxFSoO7+8Ca6eeFmjBPbtWLeXqQqxUFiATnt+dA
    FaJGijEYcsc8g81qxTBIwuRuI5yK5vTZ5pr+RpHzk9OwHoK6JFVYuQAccYoAZI7SkkZx70BSGTAHI6mpAhy
    vHUVKItqp9e/NABGM46DHtVSfHKklgavoQp5JNVrqMEgjofwNAFS0m/d+U2QR0/wq+i7uuAB1xzVEJh8YJA
    6c9KsRzmMkE7s88DtQBPOoxk8gVmRMIdYTjCyrjjkZq3NdIIyMMT2qpte4nWVhs4wB3oA3GHyE471Eq8n3q
    SzXfFiQ/MOMetWVRQenNAFcoBG3qAa4No7lXkksWRA+d/mZOfYV6DeYFpMSOAh6fSvMvFSTiOALI42x/wAH
    QD1PvQBp+G4SLhiIwqzDLRnnn2rppIlaExbjsUfOB1A9BWF4RCvBFLcTgjYNqjqKu+L9QbSbHzxHtkfhWHQ
    ntmgB2N2pWfGE3EBcc9Opr0PQLfcORxXmfhF5764tGviDONx8wDAbPavXtGh8tVwKANsW8ZhVGUYxUcVjFE
    +6MYpt1fxW+QTziq+j6it0ZUZxuByPpQBqVyniHR21nUBCrLGy8sx7it6+1O3smUTtgN/EOgrNvX+3XMctl
    KYxH8zS9gKAOM8R6dpmiWUGmaxqEXlTSicK52ghTnn8a5vw7rH9t+OLmRLu3udHtF8u32H5iTycfjxXIfEL
    Wm8T/ECGC1dZBcYt49/RUUnlfr1r074efDax0G5S9Vj9njPmEN/G/r9BQBseLrSMWdpZxtudmMr84Oa8/wD
    E17q1jrWmaQ91bT2/3irDa0YPb3NdZ4gmN5r8j2Uh8uMgZBrzP+xrnWPiHLqN1cO9vb/M272HAHtQAvi7UL
    Dxz4jPhjZtWDaFfP33Xrj2r6G0WD7DpVrbr8qxoFx6YFeY+FfA+nWPjFdct2VlSAgKORvY5LZ9ccV6Jc3jy
    N8nAxigDSe8GNv4VXlZ2HcCqVsfmG4/pWogSSMA9RQBk3AbBAPJrGurZmfcB09q6WeL5sjI9apzRKwJGM0A
    c1jDHOfangg1auoMk1QIKE5zQBetQNxOBV2MA1VsoyVDE9avpHkZoAaE+bH86mjTH0p8UffvVPxJrdh4Z0K
    61jVpTHZWy5cgZLE8BQO5JIAoA5f4veOofAXhYzxsr6xdhorGLr82OZCP7q5H1JA9cfFdxNLczyT3EjyzSs
    Xd3OWZickk9yTW74+8WX3jTxNdaxqPymQ7IYQcrDED8qA98Z69ySe9c7QAUUUUAFFFFABRRRQAUUUUAFFFF
    AHbfDDxrL4U1URXJaTR7l1+0xZPydvMUeo7juOPQj6nsHtry1hubSVJraVA8ckZyrg9CK+Iq9P+D3xHPha4
    Gl6uWfQ533bgMtbOerAd1PdfxHOQQD6Wn3C1cnA+U49q5a5KuoQAc/pXTzSwy6f5sUiSwSqGjkVgVcEZBB6
    EVyVw626v5pVpDye/FAFLQsyX8/y/Kj9R3rp49pUBunQVzmjssEnnZdvMG5hjjrW2Jw7Bu/pQBYydx+nrUi
    EBM9QBVJ7lfKPGfrSR3pK4woHqTQBYaQ8kDFMZi0fv15qo90dxA29etNNzIwCqq+5NAD5cou5mBOCcdaWzi
    a4jViSQeSD2qjcTOV55P0rS0qZxaRqV5PXAoAvLBGoIAy1RqhLocZ+vanNOFwMH06UiSjJJX9aAJojsbOcm
    ritvAb86ztwwMkZ9Kt2rZyFxigCS+H+gXHzBMoRuNcdr9oWtLWOMCGMnP7zuuOSa7i/gd9OdEQMxH5e9eV/
    FfxOumeG47OOJp5pW2NIRwhBoAy9L16LSdUumtoD5KjYzNyuB3FZvjbxqdbWzsbePdD5geQ98elV/D3iTSr
    /QbgXUYTUFGwRr91sdDWn4c8Mxaoz3d0ypdOMp5Ywi+nFAHZ+DgYNRtLlpzIjJtEJ/5Z17Po95ExVSMN714
    /pFg+ly22cMyqUZ1HXNddDftFEHzjbx1oA6PxKTHI0yYKCuNbXvsd+jJJ95sHn1q4+t/bYHjYkN0Oa5XWG0
    rw/a/wBpa1MkaA/ukJ+eZuwUUAeoW9u2rQq8+RbHkk/xD2FeW/FDxb4hjiutG0WNNOskPl+Y3Lye3tmsWL4
    nalNqC3VtLGQoCC3Q5SJfT3b3rqPCFsPF+uvcapaultngSdCe5Hv70Aef+AdDl1G+V9csXS5gKhZwdoA64H
    vXtfifxxbaNovlOhX5diA8HpTfF89nocIWFUSGHo39K8e8S37+M9Uih2EDacdtq9yaAOlstUiu7CW8sLhHZ
    jsTDYJbuaz9dnubDTIoIbvytZmUvGoXdn0zXnWmWx07xAFs5ZPscHyhQcj6mu78DTP4r8eblhDwWa5mmboD
    2Ue9AHqHww0280/wjZrqsjSX8i+bMzddx5xXWHavbmmKu0ALwB6UNtLDnIFAEseGYKeK0k2BQMHisV523/I
    BVq2uDI2GJoAvyBSpHes+VCo5qxOWCjaM0wnevzdfegDNnjGKzpIsyABeK3ZY9/A5zUDWJTLUAU41KYAq7E
    2RUBXacOOaJZorWCSeeVIoIlLySOwVUUDJJJ4AA70AW57m3srOa6vZ44LWBDJLLKdqoo6kn0r44+NPxHn8d
    655VqWi0GzdhaRDI83t5rg/xEdB/CDj1J1Pjf8AFV/GEx0fRWePw/BJuLEENduOjMOyDsv4nnAXyOgAoooo
    AKKKKACiiigAooooAKKKKACiiigAooooA9K+FnxDk8PumkazK76HI3yt95rZieo9VPdfxHOQfbNVgs5LRLm
    3ZZ4p1BjljcMjD1BHBr5JrsPBfji+8PKllMz3GkeZ5jQd0PcoT0Pt0P60AfSlpYwxxRJt+ULjFT/ZkDZCgf
    Wq+g6ha61pMF9pdwlxbsOGQ8qcZKkdj7GtMoSQzL1HFAFKSJfKwFBXPeoEjiw24CrlwrgY4H0quIcnLHNAB
    HEjZ4GPcdaHjTaAAo+gqwka9OlIY15yc89qAIGHCjgikhlKOQAfbHenOAOCMj370yWUI42469BQBaMbSZYs
    cYoWIrkht1Ojm3FFzyetXY1AIwMigCnJHyuAcmrNpmMkHHNSyRsF+UY5qAHDc9KANxNsqGHrleR6ivN/i7p
    aPokhgCrt4KFeD9K9F0xg6tgc4xkVwfxJvGj0qTKKQuFYt2HrQB896VNBaNNDPHukU8AcZ+lem+E74/Y7cw
    EwxQtyhHLH/CvPNQeBNQF3GM7DnOOvrXXaH4khv4FgjWMbFxuAxz6CgD0uHU0mufOQ5DLt4PAINaCXJaIr1
    yeB1zXB6LHILhIMuX3HauCTzXp2o3Ok/D3wq2u+I4/MuWOLe3HJdsZAoAybtrfRrCXV9XPkWkQyFJwZG7KK
    +bviLrmpeKNYk1e8P+i58u3jRsrCnYfX1PrU3xE+IeseOLwSagVhtk4jt4vuoP6n3pvw88Q22kXM1pq1tHc
    abdjbJuXJT3FAHoH7P2gQrHcapr+IdNJDRs/G4jqa9wvPFmmxvjTWiCoMZGBx7V4bq+qmfTmTTG26YvEcSn
    AI/wAa8uu9cvlvtxlljMbfImaAPorxbdXmuKIrZTJaseQOpP8AhXOB7bwtZzvA/m6pOuGVuip6V2vw61C30
    jwTFrOuoonnj3FMdu2K5a30ax8Y6lqF2sphLHdFyMu3ZcUAT/B7VNJu/t9qsSHU5CSYGGTj/Jr0fwp4atfD
    Uc0VhEsfnSGaXb3Y1j/C3wL/AMIpb3WpaosT6xenLlRxGnZR/Wu0WUmQk5JJoAvQ5Aznr1pshwWGQBRBwMn
    r9ajl+9xQA5EB57U2MlJflNNyw6HANOjGG4oA1IZfk7Uj7Su4AA1BGjkAngVYWPeR6UAPtYy7ZYfpV+S23K
    OnFRW67WBxUPiTX9L8NaPNqet3kVpZRDl3P3jgnao6sxwcAcmgCjqXk2sUs93JFBbxKXkllYKqKOpJPAFfJ
    Xxs+Kr+LLiTR9BkeLw9E3zPyrXjA/eYdQgPRfxPOAtT4yfF3UfH9y9naK9j4eRw0drxvlI6NKR1PcKOB7kZ
    ry2gAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigDoPB/izVfCd/9p0qchGwJYH5jlHow/q
    MEdjX0d4H8c6V4ygjS1b7PqKLuls5G+bPcp/eX3HI7gV8o1Lbzy208c9tK8M0bBkkjYqykdCCOQaAPtY2sh
    BZ147A1UMZV+Bj2ryTwB8bSqx2PjNS4HC6hEnI/wCuijr/ALw59j1r16O+s72GO7sJobm3kHySxOGRvxFAA
    U2kdhTWzjj06UrTjIz+gqrcTfKWxnHvQBFOxz1qpNJhlUncWYD8KgurkRq+RnmsR9ZSG7Qyb84PAGcmgDp/
    O26hGgOCRn2xW/btgAn1rzyPW7q41QGK3YoqdWGPxrp7e6umj3YQEduvFAHYogk6DrVZLEGXGOM1V0u+Z4l
    Zl4xg4PStVWBwyc96AI5WNpHiPAY1yvizRv7atJoWcASKCR2rr76ISRFzjIHWs61QzRx54J659KAPCfFngq
    az8NeZYwvKR9/A5GP6Vxvho21lqKS3s/k73AZQuNp+le9ajqWqMupWmh2sc94bgIFlOFC9yK8R+M0QtPFwU
    oiSrEm8IOM45oA990Kys7KezvkcXW5c+YORz6VpfEvT4vHPhOewkjKSIN8DsOVcDj8K+d/B/jWbSbbZ57SL
    1jiY8KfWupvvjLqDWEtstrCsrZUyg8/UCgDxC6t5LS6lt5l2yRsUYH1FWLWLefarOok3s7TtkzOxLU+NfJU
    MflPcetAG5p140EPkliFPHJxSXdpZhhdXiksOcA9RXM3d0TgA8DpU+nrqOs3EdhZxSXVxIQqRoMkmgDrL7x
    vq2uiz0fT4nnbKw28SjJbsBjua+iPhl8N38LWSaz4hdZdYZPlhU/JAPQDufU1T+Bvwss/BsS6xr6JPrzD5B
    1W3B7L7+p/yfSNbvjcAhSdo7UAZc9+0svzHJ9B2p0LktnFZijbKSxzVqCXt60AapkIX5RzQreo71CvPTrUg
    Bx05oAnIzwMGrVtHkDIxVaLkgCrcRIODzQBYJBOAOBxUqYxwODVS/u7PTbCS91K5gtLOIZeadwiL25Jr55+
    J37QZZZNO8AhkB4fU5kwT/wBckPT/AHmGfQDrQB6/8S/ihoXgCzIvpPtWrOhaDT4W+dvQuf4F9z15wDivjz
    4g+PNc8d6qbzXLkmJCfItY/lhgHoq+vqxyT3PArmrq4nu7mW4u5pJ7iVi8ksrlmdj1JJ5J96hoAKKKKACii
    igAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigArZ8OeJdV8OzmTSrp4lYgvEeY5Pqv9evv
    WNRQB9DeDPihoesFbbVy2k3hHDO+YGPsx+7/AMC4967u7szIqlZg0bfMpHII9Qe9fH1dD4Z8Y634cdf7NvX
    8gHm2l+eJv+Anp9Rg0AfR11Z7IwD8/timWelRGXcVLHnJNcLoPxY0vUJEXXYZLCU/eeMGSEn6feH05+tena
    RNbX9t59hdwXVu/R4HDqPrjvQBkPY+TcPMT8hGMdz6VdhWd9jBgOORWhNagvt6Ljp3NTeUUQDBBzke1AFC1
    kaGZwrAMPvL2ro9Oux9nBfqf0rDlh8zVYx2Zf5VqJG2SnPFAF3UdQSC3iXOTPIsSe5P+TTJWdYTIny7Rik+
    xwzTWks/LWrF488YYgjP5E1oqqTxsgIwevtQBneH9ORrs3YyS6/r3NeB/tI+Hrux8UDVgpexulC7x/A4HQ/
    WvpHS1Syi8ovkivBvjL4/tLtNV0Se3JnhmCorD0/ioA8NRGiVHPGelTLLk5PQ1XOZnypx7elS7dvBoAsJPs
    Oc84qvd3Rc4HAqGVscA10XgDwZqXjTWUtLFGW3Ugz3BHyxL/j6CgDG0bSL/W7+O00y2kuJ5GCgKMgZ9T2Ff
    YPwj8B6b4M0eJpooZdZdMT3AHOT2HsK0/C/hrSPCOiRadpMCrt5kmIG+Rv7xNWZZWD/ACHgd6ANa7lJBwax
    5pTlsGporskFZCOO9QXC7/uHg0AUxuaU+1aFnGByevvUNpBknefxq9FFg4TP1oAsR8Y3HAq2pUgYHFZt9d2
    elWhu9WvLextV4MtxII1z9TXlvi39oDQdLjeDwxbS6vdjgTSgxQD35+dsemB9aAPZ1UIC7fKijJJ4AHqTXl
    Pjv46aB4ceS10NF1vUAPvRSYt0Pu4+8fZePcV87+NfiL4m8ZSt/bGouLU/ds4P3cCj/dHX6tk+9chQB0/jf
    xz4g8a3gn1+
    +aaNCTFboNkMWeyqPyycn1JrmKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigAooooAKKKKACiiigA
    ooooAKKKKACiiigAooooAKt6ZqN7pd0tzpt3PaTjpJDIUP0yO1VKKAPTfD/xj16wlT+1YrfVY1GMyDy5P+
    +lGPzBr0vR/jF4V1JNl8brTZWAz58e9Mn0ZMn8SBXzPRQB9k6FqOl6zN5mk6haXm0dIZVZh9R1HUda3jEyS
    AlSOO4r4aRmRwyMVYcgg4IrqNJ+IXizShiz16+Kf3Jn85fyfIFAH17IGc524A7VFDKFcqpINfOemfHLxPah
    FvYNOvlH3meIxu34qQP0re0/48Rq+6+8PHdjkw3XBP0K8D8TQB7Xrt3c6Z4fvr2ztvtdzHGWSLOM18Z+IdT
    uNZ1q71C9z587lmB7e34V9C2nx28LyjZdWOrQqVyf3aOM+n368a+Jd/wCHNY1h9T8NGeLzj+9t5YQnP94YJ
    FAHMRgBRimzSHHXmoVkI9a1/C1to95rES+ItRew08HdJIkTSM3sAAfzoA2vhv4B1LxvqYS3Bh0+Ijz7lhwo
    9B6mvrPwzoWneFtHi07SYViiQfM38Uh7lj3NcBp/xY+HPhrSLew0WS7e3j+UJBaMD9SWxmqV98e/DCufs9j
    q03y5z5cajPpy/wCtAHqk8xY47VEFOeeleG33x+jx/oPh5i2PvT3fAP0C8j8RXP6l8dvE9wrpY2+m2KnhWS
    EyOPxckH8qAPpqK2L4yCc1n61qmk6Ku/VtTsrFccCeZUJ+gJyeh6V8k6v8RvF+rcXniC+C8/LA/kr+SYBrl
    JHaRy8jFnPJJOSaAPqfVvjX4Q0lGWya81WfnAt4tiZ92fH5gGvNPEfx58S3+6PRobXSIT0ZF86X/vphj8lF
    eQ0UAXtX1bUNZuzdatfXN7cHjzLiUu2PTJ6D2qjRRQAUUUUAFFFFABRRRQAUUUUAFFFFABRRRQAUUUUAFFF
    FAH//2Q==);\">",
    " </div>",
    " <div class=\"lgnd\">",
    " This image reveals a filling defect (arrow) within a metal biliary stent due
    to tumor ingrowth.",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " Courtesy of Douglas G. Adler, MD, FACS, FASGE.",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6355=[""].join("\n");
    var outline_f6_13_6355=null;
    var title_f6_13_6356="White sponge nevus";
    var content_f6_13_6356=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=DERM
    %2F86948&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=DERM
    %2F86948&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\" style=\"width: 524px\">",
    " <div class=\"ttl\">",
    " White sponge nevus of the oral mucosa",
    " </div>",
    " <div class=\"cntnt\" style=\"width: 504px; height: 378px; background-image:
    url(data:image/jpeg;base64,/9j/4AAQSkZJRgABAQAAAQABAAD/2wBDAAYEBQYFBAYGBQYHBwYIChAK
    CgkJChQODwwQFxQYGBcUFhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChM
    oGhYaKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wAARCAF6Af
    gDASIAAhEBAxEB/8QAHwAAAQUBAQEBAQEAAAAAAAAAAAECAwQFBgcICQoL/8QAtRAAAgEDAwIEAwUFBAQAA
    AF9AQIDAAQRBRIhMUEGE1FhByJxFDKBkaEII0KxwRVS0fAkM2JyggkKFhcYGRolJicoKSo0NTY3ODk6Q0RF
    RkdISUpTVFVWV1hZWmNkZWZnaGlqc3R1dnd4eXqDhIWGh4iJipKTlJWWl5iZmqKjpKWmp6ipqrKztLW2t7i
    5usLDxMXGx8jJytLT1NXW19jZ2uHi4+Tl5ufo6erx8vP09fb3+Pn6/8QAHwEAAwEBAQEBAQEBAQAAAAAAAA
    ECAwQFBgcICQoL/8QAtREAAgECBAQDBAcFBAQAAQJ3AAECAxEEBSExBhJBUQdhcRMiMoEIFEKRobHBCSMzU
    vAVYnLRChYkNOEl8RcYGRomJygpKjU2Nzg5OkNERUZHSElKU1RVVldYWVpjZGVmZ2hpanN0dXZ3eHl6goOE
    hYaHiImKkpOUlZaXmJmaoqOkpaanqKmqsrO0tba3uLm6wsPExcbHyMnK0tPU1dbX2Nna4uPk5ebn6Onq8vP
    09fb3+Pn6/9oADAMBAAIRAxEAPwCO3k8xQwCiUcMB3rdsJtwAJ5GOKwmiaJ9yHDCtOzk80bkAWUDkdjXFRq
    dGexWjc6OAjr1q4i7gKybCbdwRyO1bMJyoxXoRdzzZqw5U/wDr0ph9sj0qaL3HFS7gcDitEYNu5t+DJIYL2
    TzUXDjhj/DWZ4lEM+qStCB5YOBikiZlBZSR9KqzcBjz71NtbiV7mNqG4RsI+1QWqtJtLtke1R65NIqFIT82
    cniqFlemNgswKHtjoazbszvjTfJdHQqmCDkAUrLE2Q5NUo5jJg/lTyzDtkGqTRi4tBJaK3Tmo/syKy4OD37
    1YUsw56DtmkKEnCjLVVxxjJ6E8NuskjFCuAmWyOvNY3iazZ5WmjVY2GPkRSo4rZt3Fu+51yV5yKLu+Mn3cO
    ewcZH60nZnfh+em0VPC135kJVjiVfvAt0/+tWlco7b2YnaBk+9cPeXcun6gt3CBjdiSMcArXf2rx3tjE0b5
    WRMj1xThJvRlYmHs5KfRhpxj8tMEKh4HHWrd3GoUbJBu449qLJBbgK655wO9XLmKKVHHBGCM9DVHBOS57mH
    eMI4yZFHsCM5rEQI1uzRAlFJ3kjufWt278tEPmpLIiqQAvXPb8Ko6VcaiulzWDCFLOSTzMFPmJ+tS+53Um1
    BtGNcRum0x8YHTrzTHMjj5kLMeQB3rQa1xMcuSvYHvVpLdAPnU+wxSOv2qSMFYAzHCcHrUF9puyHzEJUj5u
    Bit42q7twBXnkCpJ1Bfyy64Izg9MU+W+41Wd9DnViM9qGBz3NamiQtNEUYksSMZqCOILI6NgbvnG08YrW09
    DGyBRwRjOKmK1CrU91pGhNGLdY8qHz8o56CoxGvlOwGARkY9atvG3knu/THoKrFTGoXlU6nmqZwxZQKruzj
    LdcGiGUvhchSOvNXLpEaMiL/AOtVC5sZE8ry8pKw/T1qTqi1JWZeTAybnLqB8qRnv2NV0LQyZk+VTzkcVFB
    cKudwy44zT5HBT0x+NCE4W0ZNHewNIf3gJHRRUdxeSTfKPThfSs7YqT79oKnrgVsWix9OCmMnFCY5QjTd0Z
    iNL5mCxx05NatqrMQJPmQDPP8AKlkshIJGXABxjPpT1cRoEXp3oRM5qa0FwdzEhdmMYFRTW8LhSsThh94k8
    E+1SqRzlc+
    +KcvzkjBJ7EHiqTMrtbGdeaeDEN+1FPpzXP6hYBd6wElVAyMc11UwYFjkc9CKz7mFSWYLjP3tpwTVpji5dT
    zzVrF3izgqp4J9a5K+s3gmaOUYHY16jqNlvB25x2HSuM1O0OxspnB78EVnUjdHbT1Ry1leTaXciSPmI/fT1
    FdrazxXNuk0D7o2GRXHXdtgEHnHr2qDSNTfS7za+WtpDhs/w+9YU6jg7dCalNHeMcr2yKkhYkHHaoIXSVFk
    jIKsM5FDAqSV6V1nNs7E0q45OfpUSNkKCfoKeH3KAcnNNxtJyOR0oGWYnOcEjFPmXoQc1WR+anV8rhuD2oI
    SI93G0/dNRFdrlcZI6e4qUqd2DyaeFUrg/e7Emgq4ySQFgqJ0HP1q3ZSNEg8wjHpVI5UnjkU55tmCc59KB7
    qxuG+2D5M+57VpaFfeU4RwZFk4YE9jXOWLhuG+Ye9ay7UTcPlz0xSZEoJrlaL2sWS2cpNn81vIN6kdR7Vhz
    /MCXYZPU10MF8LnQ57OZMEEMjj+E1zs+GwvbncaaZg4uzjLcxSHiuA6EYz1qyiSyyiQREkfMGHQ/WrLJE0f
    z4G3owGaYLjJxEcoBz2zXTB6HkV42kdToN9GYz5cZ3j74J4z7UVzmj3pgvl3AFScEGihwOJw1OinsAckLVF
    7UoVKfKRXaS6flNzsqr24rIuLM5wB7148qOtz3o17mVAWcqV4lHUeorXsrkMMEkEfpVH7G2C3II5FSKCRyM
    OPTvWkFKOgp2kdBbsWyQ2cjp0AqdVUD9frWLa3Xl8N+NXVvdy8dO1dCZyypu5pNkLkd6zdTuDHEwU5IHA9a
    fJc4TOcmseeSS4nODwB0oeuhdGFndmY6Tli7gNnrQkRYkOnXtitI2cgOXIxjPWrMNicruzk1PL3OzmZFo8M
    byGKRSWxlRU90n2cEpkkdu9Pk0uSGVZ7eXDLndkZz9KJcuVaTgkZ61dkNRi2nuRxNG8WRwTWtaWgSPJ+uax
    HKkxgFTzWtZSbwFRiEzjrS0KqR5Y+7oMuSEZgpBJBBGKyLvevTGK37zT/ADJ18ndsbG/Lcj1Nc/qcTw6jPb
    CQSqhBVxxkEcZH40NGlGSl1MGWASzuDyPetPSLqXSwNgLQseY/T6UNbMvODuParmnWwmLNJ91OenFKx0VKi
    lG0tjfg1CKf5Vyjdef5ValZmi+8ME5BB5FYSxDiRFZc+p5qK6uHiUsjEDvTvY41QUn7pLfvOgzKSI+fpV7R
    THcLkbTzkA1zkl8JpFR5+oIx6mr+gTiO7SM8qQR+NTzXN6lFqnbqdNcwB0BKrlfaqxtSSXmcCPrgdTWuNrA
    Y/iGajKrtYhQx6CqPPhVaRjIkIlUuGaMHnBw3tiqn9nyTz7mXbGPUdK3Ft/MkDZwMc/Ljn0qQ28Crj5mGc4
    JzSuzf23LsctqtqYVRojv8o4EY7561ZscuV4GR+Va1wI/mKx9MjHSsK4jmhkZ4W2qBypHWi5vB+1jy31NmU
    AKWJ3D+VZV9NJGDiPC+/WsZdTvWuSkhVlBztHFaUczXjIipIZD0Xr+VLmuaLDypfEQRXpj5aMgZ5Yc4rQt3
    huA7KQ5PAAP3R6is+YKr7XUhuRjFQi3G4FPlJ7g81N2aunGWq0NS8jE0jM/UdDjHFZEhYPtjbK561oSxXBh
    LGcEDAwV61mkSRndJ0zgnsKJMKWmlyzBtkQEHdkcEHrVmEG2kXfkr3HpSWPlFQFCgY6VZgADnuuDuB5FNCk
    +jLskieVkfxAbSDxUZw4wNpGOBVXIX5WB257DJqeaURhQqMw9SKZkoWHgBQBnJ70/bmPIcA5xio0WRpF2oS
    W6LjmmmQbuQd1BNiWOKPn5snnk9DT50tFVdqu4K4YHghvb2pkQVs4PfvVtFiiG7ckuCQPQ/UdadyHoznNQ0
    8SptX/WZ5A5zXH6lYNC+SpZDmvVtThUIgtkGGAcFTnqOma5TVbAyExkEvk8DsapHRRq8x5frFj5g3RjB757
    iuRv7YKWXGD3z0r1O7tNu4MM44Ncnq9gGXMatnBB3Y5PtWFSF9UdiaehkeGNTa0dbW4f9w5wjH+H2rsnBZN
    vBHtXnV3AVbgYx3rqPC+p/a4hazN+9jHykn7wooVPss56tPqa6go2e1TqwZQcc02RA3zdB3FM4UsBkehrpM
    L3H8A0nfqcZpXG5cr976Zpmdwz+dAkWD864YnIORimHduwOKYrkGpJGOzcnQdaCkTbVZQQfnH61E0e9AWOM
    HPFMRyuPelkcqGIPHcUBZo0LKE5Xyzz3NX1jcyfvD8i1kW0rxxgg/wD1q2bLMjZdshe3rUyE7rUeo3BztZU
    yDj1rMuxulIwUBycCtqRwrbWOEHOBWdOhdsopYjkj0pmbd9TMZm2lAuQB1qKDy0UggsxONo4q1cM0Sfw9dw
    /wrOyyyFjnk5BrWLPNxMFe5ZkJ85S5wR2AHFFK5V4iNvJ70VumcLieuOpz1IH1qBoQRggGrxTLDjmm7OcVw
    2RqpNGc1tgdOTUZtjx8oOK1cDOMDFVLmRI4mIAJ6D60WNYTbZmTqikrgZqpJtUgAn86bIJ2ZmYnOc01IJJ3
    Cg4Hc9qVjpimWoJAW2RruY0IxMkrFQCnUDvViO0ECHyyD6k/0qMjKOVIGOx6tVbI3pU1e4lveK6ZlQ7T0Hd
    frVpbxEyAw/xrN8l2+YLx3Pofeq8u9Jgm9WIPYYqbnT7GMzoHlGAR09P61WlIkUjbgnrVeJiWwDkLjdntVt
    QqgeYCV7EVRk4qOxShhjieQ7QRVm3ZgpMYwM9DT7gWyo0odcKOeaNN8i4jEkbq6D0NSxymuW9i9HK5dic7c
    bQD3rMu7MLclwCEb17Gt2JUjw2N2CDipZzC7sHTcnYAdKo5lV5ZaHPxQqzAON3bmr1xElvZNhQpx1FJeW6W
    8SS27sxDfOh7D1FRXUpuIcdQTk59KGXrJprYWxJngKfKSO5qnf27DK4Xd1+WrOnBRuicEBuSRV9oo3V2TB7
    DmluVz+znc4S90nfIrrlSp/KtXR42hulaUnjvit25tAQN2foOlUhaqGwc46VHKlsdX1j2sbM2or9Qeo9qet
    3GpJVhz1rIWyDdMdKtw6eCBwaZyOFNdS8btH6kjHYUxr0Jny1OO9VZbLY0axsV7HNVZpJYJGiXa5Q4LAcGm
    EacX8JpRy+bIoJHJAz6UmoQBS0ch5Xv61hLrMlvPi6iTys43Jxj8K6iN45rQHyzLE3A8s4PNLcucZUmnY4y
    8jkgv0l2BYyuwEDGff61s6fCqW5kBIm3fKRwRUF1EpnHlhiuejHv9KtabGwudjEkH5sCklbQ6Ks3KBek0qG
    4ti6pifruPPPvWQsZXKsAp6ZxXU28qbwrg8jGR1FVdSgXIKRbQwzk9etFjjpVmtGZ9vAjFVKkpxuPSmX0Ie
    2NsEWOIsdzAYZh2z9K04o/LQDJyaR7aS4k2Bd4A6+9MpVPeuzmYrXyPlRgy+wq3GX2cnHYBa1LlUjhCso4I
    9unaq0kaefstHEisobaeDn0FLY3VTmIIoVPzuTk9z1pRyADkhTkZPXHWpLdd+VICAjgmoZbgR8FdzDr6fjT
    Grtk7gEiSPI4yOxFWI0EsQikRSAd+7v9KyDfqAVKMMfkau2uqRO8eyTY4P0qbhKnNK6RJNZSLLN9lRhHGNx
    HXaPeq6TtG2HTrV55gRiPjOQ2f4vrVOZDKhCMAAOjH86YQ1Wo97uHy9o4qk58+XhgxH+eaSa3jRk2Ozkj5j
    jjPoKVbcghRkH09aEy1CMVozK1TSg48xXDlnI4GMEVy+oWPmFo3QAjlj0P4e9eii1EhZdrsQMgDHWsufSoh
    Gs2ppcRW0udlxGoPzf4VdxwrW3PG9XsY4vtCPEzt/yzYNgr9R3Fc3IstpcLJG2HQ8EV6l4gsHhnmWTcAyck
    AcjtXA6ja+Vw2DnoPSuapG2qOy3Oro6XSr9NQtRMuA2MOvoanl7EHv1ridIvH02/VyW8ljtZc/rXcZVo1ZO
    VYZBHcV0Up88fM4qkOV3CHa77WcKp4z0xTWIztU8d8+tR7ju56dqBIEnV3QOg6g960I3JDwalTAPXIqGZlS
    Zgh3ITkHvj0p8bYweaCiZ4yfu96bGCSUPJFWoTuGGAx1GKc8Y4bOMUMLjbMbW2sMn+daYIDAAFMdaz1cAb0
    GWHeraXBmQEn7w5FS1cFd7k0j5wANozye9R3kyK+IwScYNMzJ5u0cqABUFy4+ZVHz9/agORbFOVzIx2jj3q
    uxLhTnbj9KteWqJ94FjwRUAHysD90dq0gzgxSLMeXRVcgBeNwFFLYMjMofKhfTmitTzGmewBgOTkVHLKBz6
    8Yqs0hx1qtLNgZLD6VymihfQsyXEcciCeQxxk4Zwu7b+Fc7Pfz/bRn5od2B7j1q1dS+fIqgfKPTvUkttG0Q
    ZgQ4HAHpVJHfRhCHxIbK6hlwNwIzz2qSJiw2qgPIPXgVBbTQvtyTx1A61dhVNxKHcuO9M2so6WG7mYHeSec
    DAxx/jSrHg5OB7GprXyd5EuT/dwafcttjyOhOA2OPpUsFKxCZfLXORjHX+lZZVpdQLsqgDnip7wrudWlXy1
    G7cpyD7VXS4REAx8/wBKnS50QjpoaEcYaXaOc8k1rx24YqmBnoCTgD6+1ZVg6ttboT3rYMqxocqG4xg1Ry1
    ua9iksVtHesl6itGd0bMoztPqK5C683Tr8y2Ljb/Fxw31FdFJMHlzKWWHOGK9SO+M96zmh3u5HMZYkYGcr7
    +9DVzooe5vsW9L1Uzx5lVoyeCD61tB96krz9a5a3PkEqo3AZra0+YdOooSsZVqaWqJLtvlAzx3FZOn6jFbX
    ptbltqOf3bnovsfatm6KbOOOec1y2qxRXExVgCDwSabVwoRUrxZ2DRKTlRz7UscZU4XjtXm73V9YHFldTJ2
    Aznj6Gtax8U6rBCGuIIrnHU/dJHp9ajYueEqLWLudxcLK0e7aAM4quloyMGbk9ap6f4psry3z88bE4MTrgg
    4zir/ANsWVcwgmg5bVIaNEvlZwV4APNWlVSRg9qx5pbgLkEDvg9qzpNVu4rjaQjKenUUWY1SlPZnXMYzAse
    0ZU7sjq3tVCYeXeedEuFzlQ3IrEXxIIkBmilGCAT6fWrJ1y1dQVkU56ZNCGqNSHQy9ft0JlkCKiyE5AHAp3
    gzUXaOSDeQ0XPX9aNUu4p4MMRnpXL2eoppmvRTFl8hsRSEGplo0zvpwdWk4vc9DurVnmBQblA3HjGPWn2sG
    WURSqs/IKlT17c+9aMCo8BDMfmKjg8EHrzWdcsIL0tb7lA7nqDTOKFRzXKPDyKCZEKMvb0o+0PvDZ3AcfMa
    ksQ8qOJMgnpx1qytkD8vOOn1oJc4p2ZFDLvbc6nFSGcliobEY5wOM+lQywBSNhIxx1quEkYldu6gFGMiaaR
    pxsXBUcEkZp0liiIm0DYBy3qaoPceQSGVgo5OB0+tadtcie0EkbB09QaTNJc0ErbDorXfbZVRuJ4PX9Kzrm
    yZw7QplkXLAdh6mtq3wQfLY73Iwo9fWoLxkhkZwok6gBh0z6igmnVkmcpeR/KpIZS3cjjHqPWmW8SlcYBOO
    nc1t6rsuvKSMMyxqEUkY4qTTrTyeXUZ9anludqr8sNSO3thsYSA4IA57VFe2rmT9yp8vg7e4raaSNO2T656
    UQ3CiVQY1Kk88Y/WmcyrSvzWMOMbSNy7mHY1ajXdImXKKCM8Zx71cvrcSTlgo2knaVNQxxMGHBJ7EUIp1FJ
    XFjZYluFV1cSt/d52j09Kddyx3GnyRqgX93tznA46ED1qU288qIilFTO0MSBipbFL61jnjgMZEY+eNiCG+m
    etUYya36nC3looIfMchdW4bnb2/P0rz3XdIG8DYVIHAC5YjrmvadUhM+IZUWJSdwUrtPI6/pWB4sgZIYYIL
    WKGSIEgRY3FiOSx9MUSV1Y7KNdppdzwC+ttpIGcHkE+la3hbUTzYTN0/1ZP8qv8AiDTvJlcxI4Tjlh3rk5k
    eCdZEO11PBrnX7uVzrnHmVzvJYwGzwQDx71CX3YDcBeuOtM0y9S/sklUjefvD3p5OyQSHBA+8K7rpq6OHZ2
    GKMtlegqxE46Nn6CoMRqHIDEk/LiprdUkYBzjPAb3qSi5GwjYDIweQameQsh7n0FUl+Yvtxx1p8Eh2nrmmN
    LuPgcoxzwKlD7ZFI4U8ZqALuA3damLKqAEZqbFlxZmG7YcHpVWZiuC2OvaqrXB6bsEUqL5rKS3rxmlcPMJW
    ZpBtwGJ705kwu3cD6mmOw5AGccA0sLE8EnbWkTixKuh9jNhyPvIDgKaKbFkzEqox1orU8mS1PRxdMwHI+Y4
    PtUZwXbc546VVu4PJjjG5UOMDHWpYkYnerhgTkAjrWR6MKaSuiaIojc85qC+1BVRxGDkcfSke1m8wFWJA5x
    jrVSS2ZnJ2gMfvetDZ0U4RbvIz4Z3kndgdu4EjAq9FczhoknO3cOCOcH3qWC08sZK/K3Fa0NkFTOAxHOazs
    zedWHYyINQkkvTbJGFLA7W3d62Yy6QxRSwgHa3Vyd2T972PaobzTIzDI8cYB6kmtDRlW7skcg4AKH8KPUyq
    VI8qlFFNrWRlYpxkbT/u1WtbNRMvmjcuckdyBXSOFVcKMcY5FV4kViDtwc44pMmNZ2ZSKoBmNHXIyAOgOf8
    ACo7idoyFPO7jIGMV0VtZLI5LDAA4zxVDV7OMR71wMf5xQRGrGUrMxzbmYq2MHOeT3qSe2ZIcocNyMbf60t
    vcCNwpPy8de1dHDbrtUsO3p1ouVVqOD1OX061Sa6RZ2ChgRlxxnHGT2qmHmgl2LhwCcj0H1712N1p6EEqF3
    HtisO4shuwRgjjiqQ4Voz1KH204xIAB0HPWsmS5AuclQcdRitqfTWKBiowvIzWLBbot8qnI3ZPNDdjopcmr
    RNb6b9rnMr5y3PTj8K3odBjVQyEflU9tGFQYGG47dq1IHAAB7UHHVxE38Oxy2qaCriNo8p5ZLfKKrWF/dWU
    9vBEnmK7hApbJ5PHP413UiCRSuMA/rXN6hpEvnhY0GxmBVxxto0YU63OnGZd1a5hS4mt3dRNC5Rwp4z6Zrm
    NScs6eXzzkVqrZxNaTeZJtnD7tpwWPufyrOmU3Vx5zOGkLfOQMZNM0oKMdhsELXb4mUEEfxVLPpwWP5UVcD
    G3HFbdjagKvqKuLbh4iJBnnJFFkOWI102OLubXzCm4tuUY46Gub1XSCkrSxbgGGdq16Vc2eCQigjHA7iqS6
    cXBDgHJxk9amcU1Y6KWJ5dS94L1QahpMcE3F3CoR1P8AFjo1a9yI1fdgIvpWVZaXHHh4xtdfusDg1PNatI/
    71mlx15wDU2Z59RQdRuL0ZaGtWdrMPNmCBRjBGaqL4ps7i4kiywz3IwDXK+JbdY9REdujpG3O1jnH40yOxC
    qF298k+9DOqGEpOPM3ud2bmOQnJwcdqntgM5BzntWf4ftXlsMyDOOAaswt5EjJI2T1z7f40JnJNK7iuhd8m
    WNiYspu4PvXPTiXRLlp0G62c4ljxj8R6Vuvd7V+Q7sdAOtZ93dfbEbegZEG5sDqKGOlKS0ktC9G0VzaJPbn
    dnBVgf4f8anZCsIjl2kPyX649j71yqXbaVrCm2hZdPlUMybt2zPf/wCtXYxSi6gXYcg/d7ge9Sn0FVg6TXZ
    lNIIkbgZYDBx0pJWUHqBn0q3cQCCdEAIbJ8zB+X2xUM8W3d0Lbsc/zqiIyu7lB1B4TPvVixhxOWboOlIowp
    HfPSrEeVHzdD2qTWUtLE9wUkQKNuRwMVmkm2vJEch0xk7TkA+lXXdXHlluAMbQOtRFo/m2xZI4+agmG1mCS
    oySNCG2gfMMVXBd3JjTnualjEjZChQp/SrI3IrFGLO3B44xTQaR0RSuYWeYedOzpGB6nI7gVm3cVmIpSYjM
    XPAJI2Y9fXNbBP8ApUXkt+8Y7S23Iz6E
    VSv4XW8Ed0ywlmOWIyEz1PFUikzznxlBDLEWhtjBGTkqrlgPQV5dqtuUlO9ePT1r6N17QbJrbyorW8mkTLS
    TDoRg4wOfb6V5J4u8OyWkUM/VZY/MCkYKc4wf8azqx5ldHpYWtGUeU4fw9ctY3+x13Qy/K3oPeusmTD56g9
    K4+8XETAYxxj1FdH4euW1DSmRjma2wmB1x606MvssVWFmTFcBSwIB798UK43ELkoD360rEq4JB46imlGXdI
    F+TIBx2rcxLQBAfcvzYwMHGKTcxHTmkjZRGcgZ6YoDEcnHpxQWmXInBiIb7w5qk90PMwDkZpbvfDGAwKlxm
    stnAOfSok7MtbGhNn+Hr1BptrIW4HFMibfGecntUUpMMok52HhsU33JT6GswG0gnGfSpIIsggkgpzjFU7dv
    OYFT2/wAmrhUq2QW+bjrVROaui3GyeVyoHbI70UFECxhT7H2oroiro8qcdTu9diBuGWMg44G3pimaZatGCT
    kDuT1/ConuN56ZI9auWsm0bgc465rA77OMLE10HSH5V7daxbiSTcNpIHsOfxroHl3xkLtJqlHbpcZJ445pF
    UZcurQ2FSbVFz82egq7aRMDycY7VXhRY58kfKvSpzc7XO0ngfrSbCSvojUlCCILjd6YqnbFop5NoAR+QB2N
    Mt5Hkxk8nqDWhGmFBC496hu5lbk0ZUlJaTHU1bt4iG3Yz6jtUkEKkZwCSetXQohtnZVB3cKe496QpVOiKrT
    4BXbnuAegrO1G/khLxY/eOF5wMAfSry7CpaQEjJDba5q7bZeYORzQ9DahTUmXdP0zzplkkzt6keprowCigC
    oNMjAgQjoeasyg8mg56k3OWpHuzknj6VB5SswzyT3qdF5PrU0SHPNO5Ldtipc2qm3wozxXGapa7ZWaMHepy
    Oa9EZAy49qwdQsQxLAc80tzbDVeV6mZpl2sqKrkBsDmtONSM47dD1rnbq0aOZmtxgKBhOSSfar+iassmIZi
    FkXgE/560G1Wk7c0DeUM2MkirAXI5yVPtTEdXHPNWFIA60HC7lC402GV2BUfMOSOtcrqmnnS7z7Q7f6JkHJ
    6A+ldztJOe3rUN/ZpdW7RSIJEP3lY9aDWlXcJWezM622NErxNwRxz2p+SpyB+NVI1NjOseMQnhfb2rTWPcM
    np60XCdovyKxBZs9RS+RnkDj0q5HER2yMc4pC4DYHb1oEpkVvAQcZwtWo4VXqAQKh80Btox9av2borfPtOe
    Bu7e9BlNvc5rxHZRt+
    +AJZT0zVO1tVlCEHOeT7mup1CBGQk/Qe9c/aL9ivvKbJQnjPahnXSqt07djft1+zQqqjbxjj0qvqZiuZVEQ
    2KBkkDkmp5T8vP4VUJPGeDQY09+ZirC6RqqtkjJyT0qIWhK4UAfWp4zlwm4ZPSlVmBI+Y460F80iAaeNhyF
    IPXFJDBNbPiByFH8J6VP55PGCB60JId/wAykj1NFg5pdSaO7kTAmXB9etX/ADEu0+ckALtG3tVJ2BQrsIxy
    fYVPbxodxVcEenc1L0MpJLUdJDufcAAcAfX3odcYyR/jTGkljILjeAM8DpSkh16kE9jQGpXRDvLkkFjzipk
    txkgfePc0+MKGAwcCpgF3sFOR/eoKcn0ImhZAoKEsehH8QpXTcSAMEcsOmKn3OehI2jA56UkKkvtcKv16im
    RdiWcSzFIx5ZUMWKEYLfjVa6iWKP8Aex7RIfMTB3Anpg+1WkCDzS+GXdgAHDfWmyM1yY4VJZQehH3R9fc4p
    DTdyJvOO2ztba4it/vyiH5iwPYZ7GvNfHtrYNcSQaPFcguhEyzdFKnotepxiRYmnV18xflIkPy7s8AN2Nc9
    q5kjEss9uYbmMuIxu3ABx90L6HPWmjahU5JXPnPWLL7NO0VxEUcc4PGPSsbTtQk0zUQ8bFUZsSAdCM12vin
    Q7m2uLkqGmVMF3TLBQfU1wd9FtkwwI+tc8rxZ7Mvfjc7W5I80bRmJ13KfUUkUm1Xj/hYVl+Hbk3umNCxy9t
    wpz2NXemOuR1rtUuZXOQkt5AWIb1ra0SxF5qAVl/dJ8zHsfaqmg6UNRu8udtuv3vf2r0S1062s7YpbRhB39
    6Tl0E1pc5vxZpguYFlhXay8HHQ15/cRtESGHz9we1etkIyywPjB6fSuI1mzB3NtAMZxn1HrSKg9DGsmO2Me
    vFXZYAxZCc/SqkY/chh1Q81btCHhBJ+bcQatK6Ibd7kVnuhZ05IXofUVtRFnWPPRKhS3JkQ46H68VqaPFiS
    W2kUZYFk3nGaaViKjTiVriIxtjbyeRRV+4dJLYhhnBwG+nairPOaszZtWGduct3rQSTjHauf025Bdsk7ieD
    61tIuQpzj1FZJ3PTq07OzJ/NCxMR3pLGXdIQwO3tg1DzgqR8o45PNJbfuwWBzigjlVmXrpymCOQe2KrKScZ
    xgVZQrNE2SN+OlVo0y3H6VLCLstTSsiVHt0rQMyhgp4z0zWfD8h65qwjD+LBNSYTV3cvxTbTjgjFWI5EeJo
    ywUkZGc9fSsouQOgpYZ8P82dx70EOF9TU8jy0GAd3ORjj8+9ch4tjlgmtzDGSWkwx6mu2Vla3BDg7R+X0rA
    1BWub62Vi+xX4BORjr+WaT1RphajjO7NayKrDGvQhRkfhVonI46DtVLkP1qdX4oOdq7uSKvGe/pU6KGcKoP
    JxiqZkO7BIzUsc2wgqcMOeKYnFl2WMhmQcsPXjj3qhcxMVJTr0Aq0JcjBGeck9zmpZbyFmDBCrrhWKnFBKu
    tjmr+zHkB1zuJx93+tcjcWrx3RXO3DZUj0+tei6vcrJCULLj7oK9MfTtXHzxZlZl6Z60bno4Wo7amhpF2Xi
    CPncOprX3lSOfzrC09VRyTnJ9a10V5SscQJkP3R60GNaKctC2koPep1uF5XOfb0rFEzrwxwafHKBIX5BoMZ
    UWXtStEcEA7iAD8p4rPtbw20iQXAO1vuPj9DWla3WCCjhW6qcdKoa1aGaxJifLbx0496Bws/cmbFvLLDueL
    uOQelQXMySwqjRqpQkhlGCfrRBMfsK4Ocj171SmJ28/e9KSIhDUhZypBz29Kfb3eOS+R71DKjbC7qwUdcCo
    rVoZZMIwJHX/wDVTOlwTRtpcbmUGMluuDwAPWkuLaO66qo/Hv7VXUOP4twPGfaiVn+Uj+Kg5lFp+6JukjXy
    5QCw75zmomxnJApTIoUsQRg1FIwkUseM9MUGsYkitudWUnPfFXEAMYXd+8Y85NZ+nspIKngGtk2qtGJoxk9
    +1BM3yuzOcvb4WWoW6lf3TttLHjn/AAreRY5VVhjp0PHPtWJ4msDc2sxxtAG5T3BFW/B9wLvTYJGBLj5SD6
    ipejNqiTpKoum5o+WPKk3DayDJJ4OPQ1FA7oy+WW3E/MuOPrmtDUoS0PmOw3dgB1+tVrYDCkcd6NznTvG7L
    Q+Ygyj3FD7CjM33yfTtTCWOASRmm7SemCc8UEJEm30PHvT0T5hjHTJyajZiGKOArLxj0pY3MkhUHkjBoHys
    f8qlShAznI9Ka0heRiwG88miZY9i8ncOSCO9ErmONGboGyD2NA7EsKxFxltrbxgMM4HvUV3LLHdASBApzs4
    6gn2pyzKjs4VCGXIX0NUr4JPs8mOTzeSecrj2pXHCN2STlY5WjYhEdshX5X8au3vlPo4uUZVuIFAHmLkkjo
    PcVnR2zyWBkKsYzn5wemOuadumvVSyjXMCESSCMfdHvTE466HM+JNLQ6XcWTXMEd3qUiSuEXcsSKCcNjnk1
    4L4j0wxak8Y8sHdxtOV/OvprW9Tsxcq1tYCWa3i3LMp2NGMcfiK8Q8Uac7X3mysHeUly7DA29ST70pxuj08
    FN6pnnWil7XVEY/LE7bWJ6AetdVfxmCdl3BsfxDvXO6rFwkUbK3ynAB59s1rafeNqOmKJz/pFsBC3qQOlOk
    7aGrjZndeF5o47RUXAI5yO5rq7eQuCMdRXmPh68MM208jpXoFlcZAI6Hmreuo0rpoj1IeTtkHBzgmuf1NQJ
    QxHyPwa6fV4ftFq4U4JHFcjIz3FtGpH7xOGFFyIK3yMmS1WIuB0Y5qCzDJeiPOFYYH1rTvQT1Uqw7VmvkTI
    2MFTmtVsTLc6a3tgYkYZ35xirl+VZLaRtqtCdp2jtVC3ugUUoT161PNIkkbjd8+cj3pnK07iXhQlgh+U8jN
    FVTKpRhIDleB7iimZuOpo6UAkpZgCT2NbXng4BGOcnFYtup80cZxV6JvmxmsYnp1Y8zuaMmxmGzJ702IPzw
    eehIqS1OVB2g4qyFBU7h37VRyt8uhWTcGypAxwatRKVAzgd6rKNsrEdKtBtqBT9aBS7FkY2Z6Golmy7op56
    5qss2X2AnB6VFJHsffuYg8HFJijDuagk38BT7mp4/THB4rLim2qdrCrsc2Ap65qCZRNa1faPm5x68U6aFHV
    JFk+fPzLiqUcu7BXp3q2rgg4Bxj0oOdpp3Q0MWl6EY6VKpAb5jj29aRJApJApyZfORz2NAXGOMEbear+cQA
    QSSelWZAV5VuR0HrVZVBYkHaxPNBpC3U0NOlWSSPzVLKTgjOKsXEK2tzCd4mGSHXOelU7dVxwB/jVoKDzx9
    KRlKyY6XTYrtY9twoMmSFI5T61yuqW09nPJHPGVdMZUfzrp1AQnn5T1yKzb+1aeXcV5xj6imaUKnK7PYxoJ
    BIMrz+Na9kSxU56elc9dRy2EhcDcpwSO1amk3CtEmzo3PWlc6K0Pd5o7GnJbKwBxkj0/nVJgUYrzuzWrBJ+
    7I/hOAfeodWgaNomIXDDI2+nvTOanN35WV4gVIx0qwjAkKw+U9eKZbAEDJ5/lVhogVyT06GgUpalVI/Kkdo
    nYoT9wnI+vtT8ebIpK4x7/rUTg+ZgHj0qzD1GaBvQsXQMkYXJCFRwBgCsi40i1lVgZTbzgHbKDgBu2fat4D
    fHzyR0qtPb7lPA/GginVcepg6RqUhla2ux+
    +Q7Q/ZgK3Fj3gbTknsKwdT09g4liLB19O9WNN1IiQQyMBKv6+9LVG9SCkueBavyirJGCV9GxnPtWdAzxsUu
    g0YC8A8ZrbMkf8Ay1AbPOPQ1DPBFdW58wsSn3VU5Bb1NMUKiSszNsZFjCgH1610tlcK9t5Z2Hvz24rAe2EJ
    wD0qbTJzHJsfgE8ehoFVgprmial3H5kLphSCOK5zwuXstbubGQ7UkBkUdsjr+ldVNl1BQ5GOa4/WQ1prdhe
    JyRIAxz2PFKWwYX31Km+p6E8DSW5fPzFcqQe/0rFT93lT/wB9VqtMPJCAbW/vdTn19qzGLLvzwS3IIpIwp7
    WZMDv+tOOCjdc1BCzDnqPSiZiknXKgUi+XUJ4wYXlWRhKuMhjncvt71Vt7lkuC3IHUEetSTfvFznA7VVcAK
    Rjj19aDojBNWZYF4TKnOMHg9cVfeUpD5RXAPJXO7Hv7Vhx5UkEgAdAanRyB/hSuVKiuhPKThWDHinGfFttU
    /Nv3j2PTiqryHIHY80xvmwAcgt34pXD2ZaSSSEGFzgnrtbAGaYrNFbARNLHejJIVSPl7gn0xTGlBkl8qMFS
    Noyfu59K0LOza9WJZl2FgWDjuB3/pVJmc0o7k+j2UGo3895LGSNgCxkjkAYOf8K47x74cb7Cmo26lrVj8y4
    A2ZPAx+HJrtfD7fZrieG5i2Bv3ec9O5596j1mzt9SWVWlk+wzLtUxybVRgOAR0600zGFRwqXufKOsfu0e3V
    VLKxw/c+lZOk3jWOpqJf9W48uTPfPeux1/Sli1S4jMkeIvmzuzknsK4nU7do2OSDkHBBrJ3i7ntT1V0dS37
    i4DA8Hmu30S6E8KfNlhXnenTm+0pGY4eL5W/pXR+G7vy5Qp78c10J3RHmehwuZYCrDpwPcVztzaGO7dI+HY
    HArYsJdsgGRtpurWxlhZ4ziQD5TUx7CkrO66nMXMpfiZCJOhNc5eTtHMy4O010VzuiKRuvJ5Liue1mFjuYf
    XPtWl2J2L1nMDCjLkY4NXWmJC4rG0ydWhA25YHkmtAElc1UXdGMopFyVwYw3qMEUVAGJj6jIoqjG7R01vt8
    zc2eDjjvU0jAv8AIMD34qnA/wAwJ5HpVmRuBgDpms9Dua1L9lL8pUnipmutrjBwmefasZbjyzkGmzTM2RuH
    NHMQ6PM7m6JEf7rGkNyMEFuV/WsKGUjgMc/WpN0m772PrSvcfsOpoJMWYHBGOlSmUsCCelU49xySeaeqclm
    JKg9D6UhcqLYk8oAt1bgHHertqzvIqMBgYUtnH51VtNtxGY3GFzkYPXFanlAoADyMGgwqStoLIxhk2Aj5fl
    4q5BMWTH3s9RWe7/vFAHf86t242Dr3pGM0rFkjbyFxUscoBwzYFMyCCSQaCVaTkCgy9SZmDEgHj1qIBS3C4
    75J71OUXfkgewFMWMkFhxzwKATRNAQoAz16Vcj+7jK1mBmiwD374qWO6UPt5Bz6daCZQvsaa8jIUjnn0NRS
    KQxOBnuDyKWFxwQ2Md6ueSXQOCuxQQT6mgxvZmDqGmmSBWl+RG6MR2rl2U6TqTwiRJY84Vl6H3ru7nLwFSG
    P48Y9q4zXbYiXkfd+7360mrndhanNeL2Nm2nULxkjsPWrqxC4Vnk3O6/w9dwrntJkyoBPIrqtPcxgmM4dlw
    H/ALooTuY1o+zehlQN+8IA6+laUbKyHcp2g4zWZdS+XdEbSvOMdMGrts4wA3JxyKZFRX1IZVDTM0atx0460
    yItkg8Vp2ql7hVBYl/l2g4z7VVnj2SN8u3B5HpSHGd9Cza3Bj+ZeuMVZVoJOHDIPUc1iRyMZjjO0d60bcnj
    +XrTIlTtqWTaQyxs4cgdOa5XxPp8cG24SeJmXACpnP1rqVYIxMp5A4AHGfeuc8VsyI4CqV29Ac7c9aGaYaT
    VQoaJePdgLKc47+tdTY+XEFd0L9cAcc+v4VxeloYWjKnIHFdfZyH5OSygbsfzqY3sa4qKUvd2K1yhAcuAG6
    n3qonOc9Bzmr98Vkd2UAA8j/61Zy5OEwfTiqJp/CXY5ZcBVIx/SpPsMUxBk5YcgntTbcKqjdxjirQODweal
    kNtfCWPM+RVPJ7GmXJMhGT0GOKYW3Px3PWpBGNuQxxQSvd1IoXG8J2x0qwy7hgdcVGU3MWAxj86Fk2Hk8+9
    Jl77EMq+WuOAe4qs+ME9V7VPLKpGevWofvA8HA54GcUjogV8EgsR/wDWpQpJxmrVvEbhnGQoVd2T6VDOEjk
    2I4kGB8y1JspXdgVcjBOcUknuAP6Uu75FHSq0rMWx1A4yKASuSNja3cj1q7p04tmLyO77kZQqk8emfasuVm
    kc7jkgAZ/pU9rIyZ83mNBt254I9KLk1IXidYYmXSIUl+WWWVCzuenuPwFYs1/DYHVo4j9qZmBjhI+R8+3rn
    0qPUdRlu0jjaNUSPO0enpxWPc+X5DIAWldlYPnGzHariccaL+0eU+MbSSC8kMsYjeUlyqnI5PT2rgdRgxHk
    BuvHy8V7F4o0OSRpfLBdYzueUAlVB7n296811mHyC8IwYV6Y+99R7UqkVuexTkpwSRh+G7gRag0TkbJhj8a
    345Ta3YyMAmuLmdoLhZFwdjZBFddLILm1t7lT94DP1p0paWMk7Ox6Ho95HIqDdh+uK3JQWtSd2SASOK4Twt
    dK5Tf1HvXeWDqYyGIIrRjeqOUvRIXEMiJuZwUI96oanZqXkjGTgba6HVLRodRjmRQVPJPpVO6h3GWRRtYDP
    J6+9UTc47Tc6ZdO4+c8rtIzxV9JGlyfu98VLcW7yIdq5kyNuOpq5c6fFZahHbXVwcqB9oKp/qyew9ccVa0W
    hhO3PdkCxtG22VWVjzhhj9KKvanBJBqBS4nM/wAqlZj/ABKR8p/KiqsZ3LsGOx5qU9eWqnECr561P256isE
    rnpNakpCgZBqJiAwyu40m4AkZJpGbglR25oaKiPT7w55HpVmNSw6/gaoByo3Hqas28vmMc5zSQmmXAdoIOc
    UhfHIB/OjBCjP5GmlTwTxTINOx+RBg8ZxmtPzwEJBBA4NZUb4jUZAPtQszFWGeBTTOaUOZ6mnvGdy557VKt
    wXONpGPWsiGU8Bj8uPWnfaDuG3HB5OO1IPZG2JyACefb2qRJGLKwQn8azoXMgypzgc1o2j5KEmgynFRLiXC
    ltr8dOfSrQ+Z1x34GahNukkfOCSc5qNYpA3ynK+9I59GTzsMsrYyOD7VDgM/zcY4BFRuSGxg+
    +eaZkjkZ2jig0jHQuwSFTt6jrWrZ3WxhuQMBng981zH2hgzZ5Uenar9nckEYY49utJGdSk7XNllAjU4wCW4
    rH1OzEkLgrzjg1qQSbxypK9MjtTrkIQQAQvXk0znhJwkcRbhraVRINpJ/OupspigDADpisTxI/nXAbywhAA
    BH8WO9XrRdtspO4nA6UkdtZc8VIm1spK0Bibc2zD5XBznv61HauQ3IGR1NQTDc+5C3/AuxpEYiQsoG0DmmT
    ye6omhDL85dsjac/L1NMef5SMAk1TeUr9Tziow28gdWJoEqfUuIQRlcEd6vw4UBgfpWZGmGwTzWvbYyp54/
    hFBnV0QyafaPmIz13Y5rlNUuPOZl43FvX9a6S+TzpJRENqAYA7lvSuKkk23pV/p070G+FgndmlbqCuPStK2
    mwMFiuOhNU7M7gAV4HOatZCg5zjsKSKmrvUez/M2PmFRL8sh3jqcg0sbNhi2OTxinyIWJwdxHWqJStoWI5A
    wHp/OpgSzZBwPWssz7HwM7icCr0MgSIHPTilYmVOxdRgo4x7VMJMDBrISQtKC33etWnkwQu4HoSR/KpJdMt
    CULzjOT0NRSuSxPHr0qCJ2OO5PH0FTZABD446UilGzIpmOMgfIKbKzeVxxj0708FWTGfpUbgbQPekzeLIEk
    JyCeAKcuXGAOg6dKWWI8MFO0jI46ioWbK7S4BJ4qTVa7DJnJICn9elJDFLLwmWZuQFFQkfMyjg+pq1CWGwK
    SpHRhwRQW3ZaEG9wwwB8vBz60+NCzKAQuDyWPSrCoC6hsYYgEn1JpmRHKyHDYJUntQS5aaE0qFHQTZwRvB6
    kg1WlTbAD5bcn5G6A81ZCBiNi5424POfeoJ8iNlZ2QdQPX3FWtDn3Of8AFss1x57yvIOiMvQEDsfWvHvEO8
    zzAnGTlv8APpXs99C00chYM/GSep+teYeKrJ/McqmW6HAqpq8TswzSVjze8RhzjINbPhyfzrKW1b7yncv0q
    ldKXVhxwTVbSLk2moxlvuN8prCm7SFUVpXOw0e4MF16YNei6Lew3P3JVZu4B5FeWTHypzjPrU1ndz2c6XFs
    +2WM5Ge/sa6rXI5raHrWoJuiJXOeawTcRmJjJjdtwfeo7Txhaz2hW8R4p8cgDINc5PqzvI7IuFPTPpVInS5
    pSbvtCxpuDH7pHWuikW6u0+0ahoM8tyQDuWUIJMdyDyM1w1pq0iXMcpYebG2Vz0FdH4jlg1bUTdjXLFHcAs
    pZvlOOg46UnKxNSnztJlDV7m8mvHN/AttPgZhU5CLj5QPworOmTybsxLcR3C4B8yMkqfz9KKalcpQUVZHWx
    rhApXrzk+tOjUseT27CpjaSWcccc2+RjkA4/SlUgc7SG70kbOXYrMoBOQCfWoWDAYHKmrsyZXIxz2qjKGXo
    CMdqUjSDGMDtPJwPSrVku1uBnI7dqrxfMmOhBBJ9atW0oQjIB7ZqSpSbVi46DbgZB96aQWxgZ7GlMny5HzD
    06VNHsKndw3p602YqVhbcgKwfPtVmIhlwThcZqLYoCFckt2HalTcWYMp44oJZKyAgEfNn+7UMYK7snitCFU
    C44BwMVUnXeWA4C9B60BCd3ZiwzGI9Ds7mtvSpEkjyMgdRWJHndwoIPBB6Vr6ex3bflHI6UjLEJWOiGDGpH
    SnSFUOSC27jaOtNtVG0HtnnvViUKsnzDI/hYDg/4UHlXsyj9nxGCc5PXJ71FcxvCqqchZBu56Ng9q02b5do
    6Ec8cVn3MbFxuYnHCgHgUG9Opd6lAREnkDFJ5oV+49PetGOJUjPynPqKzby2kbJiK59+KVjphJSdmad
    leYyp71qXAJtw4AClQc1ylt5kRBk4PTFbEF1J5RhLDYcZ46Y9KZhWo2d0ZmsIGvwkTGSItwWHJq5IfKCBmO
    3byRUNzHvvbcxjoTk+1SXowqjPHuKDTflRWuCrD93k5/vdqgimCMcn7vGKjnV0kKscDGQKqOrFsBz+NJs6o
    U00XjcOXZxwDwPerVlncQDlj39Kp28TMAXcH8KsqjDCq3HfFCZnNLZGqCrlVEahlx8wP86tlhGQ0Tcjuazb
    dGAyJcD0q1cyrJbbY4gsg6Nk/wAqZxyjd2M7U7xsb3Pzdcjqa4+RmuL8rFyFxjnv3rb1hpVhKgZfHBHaq/h
    yJGj3sMux5JFJ66HfRSpU+c1rO38uLczZPqaZcygPtU7tvGR0q+zCQLHuCZIGegrN1F44WWNY8Sxkh33ZD+
    mKaMKd5PUdDKQUA5HpVpZFAwQBgHmsqOVseYgyR3z0qwmWALH5QPzNFzWUO4kgZ5C0fUnvVhA+35zn2FSJE
    fLBHHtTiRt68HjFK5PPfQN4Yk8jA6EVLFksvzcZ4pm1SgwPenRICepz2oE7F9UDDoBjj61UeU+YVI5+lTF8
    QEbhuHPNUsZJd2bLdc1Iqce5OvDcEA9xmpQvfBIHXHSqYO5wV455q3HLIiyxR4CMAGJ7iguStsSXczmMRDd
    sU8ZGOCPSqKwBTz9KndCWLs7HPUk8mpNxGMc5pWBPlWhXa3VnLYPaphAAm8ldoO3rz+VWUUllCglh8oIHUn
    sabqlo9q0cbOGkkXLAfwVIue7tcoXEhWDA6Mck/wAhUNsHZyePU1ZaynfDldy4Pyk4yB1/CqBkCLz8rdqZq
    rNWidFpRFtC13IMRcqpP97HGKxLl98pLls471LaXkkOxt33TvUNyufpUV8SkqseZnw5AHHP86ZgoNSbZp+H
    tHtrsrNdTKUJyqKcEY5O72xXEfEK3ksdYfTtLhRUZH3uFDF42+bqehGODXa6Zq9nBYXbMwiuQDIdwwj+gPs
    PSsE+IdMi1OfWr53d2iEDw7Mscj5mTHAGOlUncmn7RVHK10fN2opsMgz94kAn+VZTj7zHjZxxXQ+KJlub+4
    lWNEDsSqRrtUDtx61ytwUDHc+Pw61zXsz0K60TZ11nMLi3SQ4JIxUxyrH0NY3hmfzbeVAc7G/Stp+gPrXZT
    d0c0ldJkkC7+D3NTzxnaBjpUVqcOOwqe6YsoIyB61r0JSuw028FhLKfslrc7wBidN236VoPrwAGdI0r/vz/
    APXrDJOeeg70Sg7M9xWbRsoq+ppvdC7u/PMEMAIA8uIYUYHpRVS7S1t0Btbxp3IGQYyg5HODnt0opKSRolc
    9ulQTBd4GM1gXNmYnyuCimugT5kCsKguLZXjAbAXsM80XOSm+XQwJo1Me7lWPAxVGaEjG3Mmeo9K17yEq0a
    KCxNUXjZQOD9RRc64OyKQQA9BgHpipFjOSyjJ9qklQIMkZx1oBBGQCPalYtyQqvyMHFHmOzgk5K9qbyD1py
    555A9QaALaSkYO4kinecWcksRuqsjZwCpP07VLFgbRkkL69aCbI0EkbaFwD7EVA7MNwVSBUkfUEntTn69OD
    QZLRjbSUybUYHcP1ro9OhHlCQgDnnjmueiPlyhlUDtmtq3uGIADHj1oMK8W9jVjukjcozncOcDrU73XmLgL
    gGs6yiCgOfmY8Fj1NSzbkKpGATnI+lBxcqvoX7dpBFhmzjtTsBmO7jIqvDICgYc+3pTfOJJIwR0pC5WWJAV
    jx2qJY93XA9KfHcKV28ZpDIMoQRhevFMpN9RlzYymISlflHeq4ycsRhhxmrN7ctEqiN2CsMMBUFiQ8Z29jj
    mg0i3yXY4RNjcMFhz1ptwCyg45rRt9q7hsLk8DBxtqKaBNiqkqu7HAA7fWkSp6mKtqZHJfLN79qjlg2NnHH
    oK2AAjk45zjFMuIc7TgHNDN41tTOt4GAXOenNWPLZeQc5pS4Q4JwOhp4mQ9aENuT6EkOVXd361bALw7jweu
    BVAzrgbPy7U+K6yw5wR+lMxlB7mdqNo0zAZ/d9doPX61Vtw1s4XAXHBNa05O1iHySetY9wXQMHUkdQ5Pejz
    Omm3KNmaYBLZD/APfVJNbiTduGQv61lW9/vIDEnsQeorWim3jAyQfShNESjKmyEWiqrhRjdgj2p4Ty0CgDA
    4ye1WQQpDGnuUZCWUHjj2pE+0bHQZFuB1c/liozCTtyApJ61aiCCMDqfU9qawznHGDQQpWZUCndg9ParEKN
    lTnAHY0rrnIHB9elTQsCoZgaRbloR3CqyttOCR0NIluZRuLYHTAFTNj72BgUyKYo+Bgf1oEpO2gC1SNwwB9
    N3WrDxH+H86UPnAAyOpqyZYjGY/Ly2OGz0pESm76mXKpwcE4I6elTBWA7dMVZijIyCMk0yZWDJtAAHoetDK
    576EctytvCwhLhTj5D3I7/AJ1XHmyMZZmLMxzk1ZjtC8oPVv4cnpWzC8UNjKkiqVAyTgAtnsPxqQdSMfhWp
    zV9EfKRnLgY2kt09sVjXMio6ls+ldRd6nJ9oEcMUYRiAC4zj05rC8RKsU0drG8crrh5WA4DegPpimdNCTbS
    aK/2hQjApk9ueB71T3Eo20vnPy/SrKxHyx0LHrxUhiCDH+RTNeaK2Mt95jfK4fHBrEvrIFWVwSetdYYi+MZ
    2+p71XubIMh+cg56CriifrHK7HiviGxEcjbQQa4u+txkjFeseLLILuxuznuK831KPDt0rCrBJ3N3JVI3Kfh
    dzDqBi4KycV1OPlZfTpXEwym3vYpOwYZxXcSlWZWUgq46itaOxyRfQbCwVhV+R90ATqM1nAYcCtKBdwweMV
    uiloUhH+8AZsLnk+ldpNZJpsl/dQ6fHiIR21ijrvEzsMl8fxHFcfOQJtqjJJwK6O8htbSznHm3stxpssSO/
    m4UbuWCDtjpmpa6Ezd2jD8VxRW2uyRRRrESiO8S9I3Kgso/Giq3iG0Wz1pkjkeSKRVmjd/vFXGRn35orF7n
    RF6I9pEhUDGcUpmBznkkflWTFeMclTjPY0G47E8nNaEezL7ylptj4Kk9TVK+Ia5d4kWMMcgKMAY9KQTbgQT
    zikZw/JJOO1IcY2ZEiqevzd+ajeB1bMRXa2PlPUn2pXIQ7h0PapElyCuenrVJlST3KTjEhHGQcEDtT9xAG4
    AU+WIB3IBy5yff3pqwsV5bIPUMKTBvQmhAY/I2COxpZFBbDLgd6j2iN0jcEbvusKmO5cA5NIm9hIwpIJAA9
    asoqA5BPPvUO1WHFIAQ3rjsaCr31LCo+/CsdtX0kKpnHzDjIqnB8wAzyT+VWlODycfXvTMpO6szRguyHUqc
    qB+tXon3cn73bFYkf3gfetu2b92uAOvXHNG5yVYpbE+SiAjuevpTJYjkqOB14pztnBIzjjNMMgbHTI/lQZR
    RCHKnB4B5qH7QUY+ZnHapWcAkj86qyxLKDuyD7UjphFPc1Ldo7lGV25KEo3ofeq2nyrEpGMEsd2R3qvC3lB
    VbJPrWjBEHjzjGetIiVoqz2JY5BISFYNmiKPYx8wZBHr3qX7F5Mfm87sfKB3pEljlU9VPcHtQYX7Ee7zGQA
    AMOpJ60QvvXcB0OCPWq24rJjHzdjUVlPLb388bgBdmUYevQihmnJpoR3B+/uGeaihh3AHJx2qW6UqPb2FLa
    uBgPwwHSix0KVo6DY12cY+XnNW4YtzHgbh29aTy8oecYHSnq4XByA4HHFMzc7rQQxcHy8kk8r6VU1MSTWyw
    sCqRAnHGMnvWnMscjRvFwxUbgD/Fmqt7tVJVZsoByD6jtTQoTszhNUke0vY9m3y2OGB459a6TRLkSQZPJA7
    VhatEs9wgKsWGO9ben2iQQBmOXb3xWa0eh34jllTV9y8LkbjuB9uKcJ90TqpIUj86gQDfzk479qmWIKzHGM
    9Ks5LRRpWMyT2q7MbxwwPWpTGd+B+tZTK1o0V0jqQWIZB1I9a17S4SVQw5Xvmp6nPOLjqiu7hSOcjP5U9GB
    U7e/QUt+qvKTEpVCeAeSKQqUjx2x6U9xqzSInkK7iR+FOjKhsjqenFRbSQCex4qaBCRkHI7g0jVuxORt5zw
    R1FJE/zsVJJFO2rt7c+hqLZhz1z60iNCdZN2cNx3PpU0ZGSR8xHX/61VR98YHHSrCsSQM9KDOStsWy6pCMR
    MXIKjPT/wDXUQh+0xyGa4EWMBMnq1WwhaGCAOMucjA6ZPOal1K9TTbR3uI/OcDy0+UbfzqTNSd7R3OY1u4A
    QQJ5YgiO0bTkk45Oaw4kJJbrz3p99MJGG0cn5qSBJWAzgD69KD1IR5IFu0VHfn0xVm4jUpj8j60ywjwxZjy
    x4zU9z5ZjPzgHOAAK0SOabvMqLLsxnkL27UlpqsNvdrJdKzRRjhEwNx7An0qBo12k84HSs+5i3MR3zxVrsH
    JGW5h+Nda+0WDwGztklkcyvcYy7egHoO1eK6wGeRmx+VeseJX8rPyqXwcBhkenSvM9UgxnHUVFaOh20oqMO
    VHH3IfO3oBXY6ZN5+mQtn7owTXK35CvzW34Sm821mibqDWVJ2lY53pKxs5BINXYHyAGBqgMgDAq5b4yD+ld
    SGiC5P79lzgnpjtXcQwanJbFL7Q7a5mm2M7m4C+aVHykgHk/TrXBXnyXecbuQcHv7V014llqd699DrNrbxS
    BT5U5KvBgAbQB1x2xUvcmfQreI7LUkme+1KAKZGC5QgqmOAvB447UVZ1fUrOa21mWK4LfaRFDHEQdzlMZlb
    0zRRc0hex1tmyDzVljBZxjdzlfcVPBbTSLJsQ5QEsAOgqjbzxghQSM9zzn8a1IZWMM/k8s+MuGPAHt3pG8l
    bYpjDHjK8dM0jZAxg8dKkELA57jvTJvlPzdqQ9CJ5C0ZVufeo4pij4K9e5qztVxxzjpiodgclcZI9admTzJ
    lhZNy4YZB71Kqgjtn9azW3wnP8J/SrCzk4Zcg+nrQtBOPYvBC6gMQPfNRcxsFk+72oinDDAwG7g08ZOc8g0
    2zPVbkhUBcjB9KRhwCQd3oelMXdGo6Mme/arETo69cr60hXGQnBzjBq0XLJjGTjvUTxY+ZenWrcKZAz19DQ
    KUkTWNvuAY5FaiHaOOKjtQoAHFWduT7deKbOOpO71Gg5XIyPrTDGWBJHFSIh831Bq0qccYpEc/KZ0i4IyOK
    iY46HBq/dKBkjr6VQKBlJHDfXpSN4SuLEFdgCcityyQKFGDWPaRgyA5GR1rbUiOHfnFBjXlfREl1IEXd0Ga
    5XUboQXquDgYxnPfPSptb1VkjkCAtgcY/niuXmEtzGSzkliOB61MmdOEw9leR16p5iJIGJGM1Y8lrgxtdYL
    J02jFJYR/Z7SKLOdqgEmriMShAAyO5qjmnOzsipPD+7IUEntWePkchj1HWtlztUgclRVCdNhDYBB9aC6U+g
    tnJk7Dye3vTpQ3oCOc+1RWw+bLD5R0x2rRs0Eit0655oFKSi7lMl4wOCpIyoA6+9Z99dfuXaXIC8kAd61rs
    OHUHLBVAUnsKwNYAMRIZDIzA7TxnPYUXsbUbTZVsLfzp95ye5NbcsYEQOVAzwoHJ/GqumQmGHfINpPY1IZ8
    k7RnmlEuo3OemyHJGRhc5UVYc5UKoziqqysCARweDU6tlwM4xTIaJkhDoTjkjmqirJbSkxnMZHPPetCOUBe
    ODUW1pWwR8tDVyYya32Jba4Wduu7HvV1wCvzHmsSdGtXVoRk55UVZtLxp0G5SrDsetJClSv70did+oK4wO1
    SxHbz0z2qItz0OaaXAzk8AZJpsLNouK3mDC4x61YtooSG89mHHykY61kWu9siLO725qzFI5BR8An37VJMoE
    8jlpPk2gAY47VXkkfcGjK+
    +fSiWURgKmT61CJA7YX8qCorQetzMqho2KuO4FZ+p3s80YS4mdkUkhWOcfSrpYRMTgOMdM8fSsu+3u4cAKO
    maRtSiuYrqq7lMjEZOAPWr0bKVHG2spi0b5LFt3X2rVs1LqCSBnoD2ppGlXRXZdVow/QsB2HGfanTxABDvU
    7+flOcf4ULF84CruOaQxstw0WCXXsOefaqONu4wouwAsAfQ96o6nAbWTDbVkY7ldTkr+VaFxGAkZPzAkqCO
    3tUOsWxsbOOGVB9plwwyOYlzxz701uKMrM4DXoIvLVppCWJyxHUD1rzLxNHbQJGba5MsjglwU27Dn7vv9a9
    h1OytpXmie9tUMa7yZGKq2Byo/lXjPiwR/wBqXTRoqRCQhQrbgB7Hv9aVZ3iejRem5x19ksSeaveD5fL1Nk
    J4dTx71WuRuBPam6JJ5OqQ54ycZrmhpJM56mkrna4wZAcYzmtfwxbpd6kkUoym0n8ax5BtnGO9TW0jxTZjb
    a3qK7S15jtTiUT4Y7UVtpOe2a7C4u5bX+1re2061AsViktkMAbzIjgE575znIrjb9GePoASwGT0rbupdO0f
    UBC99rBvbVRF5sTKoHGcLn+HmlLciauzN8aORrUm9dnmRRuIwoHlgqDtwPSisvWp4rm9kmt5biRJMHdcEGQ
    nuSRRWZvDZHoi748K2GHqBUg81M+S5XPBxxmr6GIwKzDDY6jvSxDPO3K+tU1YpTv0I4b9hhZUIz3A61qWyw
    XlrPiaJJYgHCNwXHsapxwxTctww6VK1rGxDKCrD8qCZtPbRkUcqqeRj3p5jVgSNuSPWka32RyEIHduFJONv
    riqpOBjJQk4ANXF3JfkOkdT8uMsKlaBFVWXBDcg+hqoV+feGAYDlc1YhkGOcYHvT5UJ6CTRFuRjcO9ENwUU
    buD296mXbITtODUU6BWGeFbjNRJDUk9GXo2WWPoM/XpTBEyy7gDk1QMjxMPT19a1LWUOOQDkULUJRtqi7AN
    2FPcYBp4Ujkqc/WoVPlFWbjJycVdddwDDuOtF7aHO2Phcq3zN0q6k24Ag1ltuDDdjHrTGcxtnnHoP50m7ku
    nzG5G4YAZ5qwr4XJrNs7qJxy4De9Wppwo6jHTrSOaUXewkr4LDI56ZqpdQvjcpwe/vTraVZmbDZAOBV948o
    AenqKC1JwaKFjLtlw/DHpWxLGJYj8xIHG2sue3yMEY5/Gn2l04kEU/CdPrQVUXN70ShrK7bSSIhcZznHPT1
    pnh61H2VZ3GSxyKu+JIA9rmPJXGeal05fLsIVAAULQX7R+ySXcnJAGPQdaVZyhAbOTxxVYsxchcGlbftAxz
    39qZjyl0upUZqGUb1Ht0pke4ke/NOkYIpJ70gSsxkb7l56dKmjyNoDkAc7qqQudvJGAamVgEx260FSRPesz
    D75bbxz2FYiIJbpy4XCE4OK0JrgmNk+X5iMnHIrPBxvz0JoNKSsrFm4cMu1eoFVYFJJP8AFnNKsTsoYZDfn
    VuGHA5HOKZpdQVipIScButOVjntntmrDW+eXJApGi2pnFIammKgJIz+PpVuBvlVRy1Uod27kd+AavQ7jxwt
    BnU8h7Rb3BcqmemTVGKyeS8kKSDavyl16H6VNdoZ7hVUkhWxkVZ2rAiJnAA6CglScVp1I5oSnCtk9OtVzEQ
    TuJY/3akeT5/vc/yoILOCDmgqLaWpo6Gse4iTCg8bicYpNQlifUJ5oVATO1SBgDHHFV1V0YIBw45PXFQ3LK
    zCJTx7VNiIq8rjC+WOCCOgpqfK+e2Kic7WAXkZ/SrExCjaPx+lBtotENf5vu8VVZJJGKHp71ZiYYPHtU1rE
    XlyV69fpTSDn5SgLWJJAs8bbSOXHVffHeqxkbTb2SG5P05z1/8A110WpweZqAWSRMpH5jMR8oQdjj8K5CKa
    XWtflmdQIy27avRR6Ck/I0pP2ibltY6RZwYwQG5GMdMipLeeWJZmgKjzV2nIyQPaos+W/ONpG3BpwuoopV2
    ELGCPnxk/lVHG1fZFm2uILGBpJ49020NCWXO5gemfSql3PKY5Li8k3S3nMcSkHJzjn0A7VSurxZMEAhkO1B
    /DjPUj1qhOxYncWyc42/yFNItU+pV8a2Udjpk0LXIkkR0LJtBPmMMkbvQD9a8P15QZWC/cFen+IWJXKD5h6
    nv615n4nk2vsUhm5LPjBJNKovdO2imo2ZyV6wTgGs63kK3sLZ6MKtXkgJOR0rNLAMpHY5rlRzVXqekytuCO
    Pzq7pMkUV9C9ym6ENlqzUbfYwHOflFWrcZAx612o1i9LljUGSSSQ4zEWJAHpmuh1qfVIrzy7TQIJrNUUQSS
    WpkZkwMZOc59jWXp9tZziX7dd/ZVXlT5Zfd+VS3DWLSEjxTdJ7CKT/GiSM5S1MbxcS+sfPapayeUm6JI/LC
    8f3e1FVdZ8oXreTevergfv3Ugtx0554oqLGynoenOTGxKn5R2p0EjicFHyCO9KIR1jc/ShY2/gwpHTNNM3L
    aqFG+XIx6VYCyREMxLQn0qrHLn5Lgc+1XRdsY8YHHVTQYttdC1FskUlD+HY0xreGXAlXGD8r063mRFDgYLD
    5h2qaUqH+UZx94elGqM3poYmpafNFFtg5fGVPr+NZlrb3kMWL1SrZwGPeuuEmFCucMBwTTZYvtEe1SN30ql
    IxlXdN8r2MCGZEZQcY6ZFW54/MjPfFLcaXhFVBtOfqCPWoVdoJ2X5mQHjcKvctTUtUMjJZCrKOlWjC1rtK8
    xsMr60qMsjs0eAT146+9aUoL6ZEWVcR8Fv8Khop1NVYgtZd46gmrcMhhfbIDtNY4DIcxjitK1ufNjKt1PrS
    9RVIpbGhIgble9Up48DJNQRTvC7JESwByA56VdW4ikX94u1u+R0pEpSgQ2yhWPXOelaUSl0bH4gVR2LnMbb
    h2INXLJ9renrQtxVXdXRE0b2kikoVjk5VuxrVhlBjADZNacIsdRsUgugyquVYMcKrHuDXJXG/S7kqHL2obC
    t7UjFWraPc3GYtx2qrPFgZx+XWoYrpJhwxw3cVcQ7lHPSqJ1gwQpcWzRXDHKKdg9DToCJIOmAvBqI/wCsIO
    OTwanA2jjk0rEyfQiCDcdo4zSjAcMT2xg0+N0dipPIqEgBs4A9s0DuPuH2wNKF5XGD/OpJiCFA6EdDVe9lK
    abIu0shG7PpxTbeYi0hM5G4qASaQ0na4/y+DtGPao1DkenNSu5yMLlQOtQox4KgYPJ9qZabHSQsy46E9/Sk
    ityqkkEnPNTDzcZUKR/dpst2IkO+J1K9eaBXk9ERsY4iqMcbjhfc1aKqiluNorCsJF1W+M6qywRHCk/xNWx
    OxkUJj5e+PSkOpHlaiKZUdVznHf2pkTK0rxY4HSopImeNYl3Be59qcyi1BKMZHA5J6mgFFW0J/JHODz6VJE
    QpwabFKJFwflPWklQoAyEk96BXb0ZIZBGGY/eNZk92Xdvmz34p9w0jggZxVcW7E45yepoN6cYrVk0Qd2Ug8
    +laMTkRjbz6gioI5TAuE/1mMA9KWGUoQFOXFBM3zFssUUs5+Yj8qzpmLsc9SKsvIcjfyfyFMC7m9xQTD3SF
    W2lQwxnvSTuFHzcE9qmZAo5ycc1XmiZipJ69h2osaKSbH2r5YL1yMmtuyf7Nb3DSRmSEqBnOMH61kQwhSAB
    x60uo3rrbsN+MrgjtRYzmueVkYusXs7Ge3tnIFzhWAPJGema1tI07+zbCN+P3pPz/AN4jrisnTrfM32mXk9
    F9BWmzSTFAxb5RgDPAHtStrc2qy05Ft1LNwQYzggsaz5Jdg5yW6CrvmeWQGAY1QuDulJX5fWqRjTdtCoWAZ
    w+d3Xj1qvcS/KoUMhHBOevvVswkkt6+tQMIiwWVwqDqxGcVUUbSkjmdXQtE/sCea8u8WRPFKBIMNtBx7HnN
    eq65dCKN1ttwRlIJI65ryTxEkjTMJd2c9GqavwmtNuzZx90CWzmqDjnFat4gDH2rOkxziuU5ah32jt5ul2+
    QT8nStOwyH2k1leHip0u0I44wa2VQw3Trx+HQ12R2RvB6F610+71AypYxeaUwTlguPzNVLvwvrXmErarz/w
    BNk/xptwp3CM/KTwM+9bF5p3h62j1BJbO9mbTmjWZxPgvu4LAdsGibIm7M5O/sLqxnMV5H5bgA43A9fpxRW
    j4ightdT+z2sey02o
    8A3FtysoIYk9z6UVJcVdHpctuA6vCCT354qdUWRcjhh1X1otRlMueG7+lEkYEqYYjPG6kdNruzIriNWI25y
    eKi3PE2JVP4d6uW0bPeKm4Jz949KtyWhQDeSwB54picktGU7eUEHyztB6g9q07ZkJDMcg8k+tZcltsyIjxy
    cU2zF3cSOIS21Oqhc55obE6fOt7G5OoEZIGVb9DTIyFbrg0sb4XB+ZT+lUNQL/aMK2EOOhoTsefXheJpvMg
    4JB9KgvbaN490RXzCMD2qjDC8rqGcnHOK2bK2VAPlGacZNs5FJU9mc/P5lmUZkIwcAkdavQTCaAKG5Hauje
    0SWPaVHHqKwLvRvsssk9qG3E5K54p3N6eIjPfRiRptU7uuaSJQz5YYGcZ96iNxuzG+VY9c1Zt2TBBP0oaN7
    6EVxGQ6NnIPBxTwHAx1xVjagQjg+1CZUYOKTRancj2AspUbXpyu0bYP5051PUDpUZKsOQcfyqQvc09PvWhm
    V49pI7EZH4ir15bG/t8W+944wMowyRn720elc7HmNs9Vz1rd0WeSK4XyZvL8wFM4z1oMakeX3o7nNXnmaHf
    JE4DQOPvK24Lnoa6C3nHlqcgg9Khl0y3uDPZ3yqk0h/dz55jcdvoe/pWJoNw8dy1jcNvMZIQ/59KE7OzNZJ
    VY36o6cnIzjJo8w5we3WkwEAbPFQpOoBYjBJ61pY5FrsPYMlwskYOO/wBKkmkDjIOADTYTvJJOfSmSxYU44
    FTsPfRiuwaF0cjy2pitvgCYzIp/MetUsM7bQePWrccN1P8AZ4xIi+WCI93ABPJyaRq42W5KiuM85B7elLgc
    L+Zp1u/mruZSrqcEdcGnNt3ZUYzSM7iwOVYbuVxRqSpJbsoDM5HbpUbMB9KAQzcn8R2poIq0uYyNElWEvZO
    37wEsp/vitQvtGCOfWszxEqRbJo4Ql1EweOSM9V/iVh7+tXoNl5bJMjZRhnils7G9RJ2qdyUy4UAnNMj2rl
    h/FSSWzNjBIpwiCjAJHpTI06FgFRz0prvn5iOOgOagVVLHdyMcmkWYKwBzgdKBcvYuxophY59+nNU1dppCF
    O0L1Jqae+Q2EsRAaQ8q442mq0BVIIyBncMk5oHFOzbJHfBCp1PenIpCgsPmJ6+1IApGAxwamiTIQY470glK
    yJEUyt6kdAanSDJG3r60bljOAR6elQzXgjRlU/N1oMlzSegtwRFEwbYWbgHuPWqKXOcFuRVW6nJRm5OBye4
    FUbaZVWTazAE8BjkimkdMKfum0bhmX5T8vtVK8XzmXeMqRkgVEs6gYJ4HpSrN8w4B9Caqw1Hld0XbaP5FXG
    M1akwnygZ4qvbyfN96pVZncD/OKVjnk3e5VlmYOdowBUDMCwYitOS3U5J6mq0lsCpC4AosVGpEqyurxkr1r
    MkdXBJ5PtWi9kxGFPH1rOu4XjUgHp3FWi4uL2ZzetEbcnBHPQ15jr0paZs9j3r0jWXYK27JzXmXiDJlcgce
    oqKvwnVFe6c1eEOxHrWXLwSB0q5dvtYlc5qhISTmuQ5KjO48M/NpEXfBro1BeYP8uCBnHSub8KnOkoB1BOK
    6eFcxxtnHUGuyOyNqT0Ir4liwJLHGMitOe4vbXWYo9Sk08yXECw3SyrlNvUebj+Iccisu88xt8iIzBMFmUc
    Lzxmtu4trHVLg3d7Y6zBcSYMsUUG5HbuQT0zRIUzI1mO7fXZTqKxCZQoAi+5sA+Xb7YoqTxDctLeTTPA9sI
    41RIn6qgGFz+FFNGsHZanewT7ptinaBxzViOUklHG7ntVbyY5MFMh+7U7zDCy5AJz94VB2uKexeJGDsznsT
    Vm1u3kh2uMMOlZwMgVt33c5BHpQxfadvB6mgydNPRl2efccBOV64rR0jVLiwgkgtWhgW4cB5yuWUdOvpWPb
    zoIxGOXbPWlgnBycDaTjHvQROldWaNK6tUivilpcC5hU/6xcgP68VUmHmPz1FOimMR/djK5wR6U6EKxff61
    SSZ5+LUoQ1J7ZQK17Xbj5f1rLQIv3Wq3auAaqx5Mnc14iGB56UTICpB5zUMcmF9qdI+eQeAOaViI6GBrdgA
    3mIOnesRDLFsy2/Ppnj612N6yvENwCjG0/WsJrYPKyJgMc4HYiktdGepQrO1mUftu0/MTzxVmO7VhywyKqy
    WDKCI0wAOB/hVTyHHy4bdRJWO2PLNXubsU4wTu3ZpBt8zKnr39Kxgt1CpYRvx7Usd+CpIBB6EehqBqnfVG8
    uDkZ/H1qW1cwv6/U1mWVyJVB7VcJyeB9KCJRvoatwHuIn3Fm7/SuW1O2a2dZ4W2SBs4A6f/r6Vt29wQcSHk
    1Nd26SxltpfH3s96LCpzdN2exX0nUFvogudrrwyHqKtkIjBfvbu+a57VXjsLuC502N4TsxPGTkZHcH+laem
    zpd2qTIwJzjHoaqMr6E1KXL70djWhxgFeMjNJK25SCfyqk05CgEkN1PFOW4DRgkY4wSapmPIx8alZDk/TNW
    WbaBtOGXn8azpJ8/KDnnpVqCbcuW4Y9Ce9JlTT3LETYR2cnfId7fU1BJOOcfhinFmbAGCvcU+SEBVOB6kDt
    U2JTSepWiZpHz0HcHnNX0RdmTzgZ471FGiRktzu64FRy3BaQRoAg7k0Dk3J2RBqmXKRRMu/IB+TIwR60tvY
    RQW4WJzGoHLZOKmEQxheTnOacELq+ThVGBg9aEiufRRWxmSz3duUaNmeAn5lI5A9autPu/1fzYGTg9akMqv
    CYlXDEYz+nNY2JdNMiyOHj3bXZTnafb2p7GkUqnk0agclyWOcH7o6fWlCZYu5HPbPaslbwFcRnJPSp0kkZQ
    FOF7lv6UXB02iYjBIf5V9BVqL+FR0xgVDFOrptJ45weuaZHKTIfLBKDjPQ5ptXJ1NASBXCjBOO3arumxy3E
    uyCPc+CR71l2pAc9znr6VsTTwQaZBLbzeXfmTqHx8vvSMZ9kY93cgsCzfNnGKz7m4GCXwoHUnpVfVtTENww
    2Ru3QY5U+pJrE89vJUMWkZuxJwDRsd1Kjpdl7VLuSKXy45D8y4cKeMHtWfHfPnAwBk9+KmSDK5cfOepojst
    xJI4HrU7s6YckVZii+YgccdiKtW11ufBz+NVJbVgnHA9BUZfyxEqoFCj5mzyfrT1CUYyWh01vMAoPBNX4rh
    UGA2T6muVivl29QD0qb7cVA6nvVXRxzw7bOia9BbqM0hucg5x+Fc8Lo7/lBweeacbtyemKVzP6uzeMilODz
    nvVG9VBGxLZJqvHIVAIqO7m/d4YZAq0ZcnLI5XxAp2kjHvXmOvZWRh616Rr0hbJc4B4x615zrrLuYDpms6v
    wnZB+7Y5C8+8az361o3mCSR0rPbvXKctTc7nwoMaVH6EnNdPHj7OwXs2a57wpEf7HjI9a3RxGx+ldsV7qNq
    OxE80imSKOR1jkwHVTw2Dxkd66m5aKzuhbXHijU1lAG4CMkJ7HmuRmJEgI6jnNdpDZDVFS+vdFlNzKATsul
    iWfj72w88+1JlzjrcxvGOl+XaXk0eoy3txDs8/zlw2w8KwOTlelFZ/ibXmeTUreW0MN3OyxSEnAiiTGIwv4
    daKRk7s7q3uACyZyR29Kt+WhTcwLKOc1mtC+/eq4PetC0Ztm1uBjioR7NVLeJajBZAAo2nvntTS+G2tjmoY
    mZpjgFcDtUk2G+92GKZk1bcp+YrXGS23BxVtCillAyD82aoCBUBYL8vXFO814pkCDdGe/pSRrKPNojYtCki
    ZBx6inRZt1bcd2TkH271BC/lk7AOeauMithAwz1we1UtNTzq9PnTiys9yPOO08EZIrRs5HOMHLHoPWucK+R
    O3OVJyKsfbsEKoJJPFao8OpTcZOJ1K3vkTfvRkjhlNRPqSIX2/MmeMelYsYZ8vKfxpJJSSQAMVLCFJLc1G1
    OOeF0UMMEEbulZ7zsZVKNgqeDVFztYZ6Y6VKm+QAKRWV9TpjFRV0WpZ5WOBKWk6cDHFWrGAn5m5b1NZ+Vgb
    qd1Sw3MrknOBTuN3tobrRcEZH41majpsdypKAJMO49akt9zn6+9SSgx8kDiq6EQqSpu6ZzMay2ryK2V284x
    Wna3YdBk4NXVCXH3lU49RUFzpCuS8DlHxkA9Kk7ViYTfvaMez7l6jPtV/Tr7yWCy/MnQg9xXMpczW7lJlO4
    davWs6yghicii5pKnoaV67WxeSA/fDIc88Hsa5W3a5sHb7P9zPKHoa6BLnK+Uw+UnOaWS3WVSFOcnuKdrl0
    5KCtIrWOr20sflv8AJJ0KntVwSnB2cj371z2oWAXLR8MO+Km0K4Kbbadxk5KljzRzPqEqUbXga7v86qBjPU
    1NcyIsGBu3nrg/rUM8eSCSR2qJQ7um/lF5A9TTdyLJ6lyynuhtO0eWOBjrirxnmcfNsXtmqsMqjLk7RnFR3
    Mu9QiEkk5JoRly8z2NETKsZA+8eCazixWUK27LHvVbztku0Z4x1qRJ9/JznOKTLVPlNhDghQ3BGT60XDOAO
    NqHt61SimIIYg7icBc1LdShVXzcqG5Az2poyUNdSF7kxMFz16+1Zl9dNJA4bAHUEdTTb91RgyucdyayLm43
    RkA47YJpXO2lTvZoltpQUOw5CkgZ4JFX7F2lCg52g9M1zFrJICyAgKo3Ek1q6RfDIyRgdAetKJdSm7Ox05k
    SLkLnHBHpVc3S7mAwp68VQvNQRIuDjisY6gDKTmtDmhRbWp1rXBCghiCOaxtR1V5pRBChkJxnjOPx7VnX2p
    EQEJwenNHhxmKyyn5nY8setJvojSFLkjzMeYJ2kBkJLMeFzzW1bWCRIJJiHccADtUcJd5d5HzD17VZjLKCx
    bI9DRbuKdRvYYkPmzNtXCjr7VbSBQeWZ8/QClhUmA5GM9afuEa4PQelNGEpN7EU8J2kbR0zWHfWxdgQ5Cry
    QB1rdmmDL8pPtWeYvMnG8/Jjn3pM0pSaM62tR1A4q9HACQOmKss0Y4GAB6U1ZhnC9Kg0dSUiVLdSeR+tOmg
    iCcZB7YqBmJOA2KjklKjnJAFWkjD3m9xrSeWMMDz0NUbu5Plsu7inySlgRjI+tZt24wd3Bx09auKKsY2rS5
    Q5PT1rznWZ8yOD612eu3GyNgB2rz+
    +YyO7E8Csqz6D2RlXJPPcVSerk45qsq7nA9TXNY5p6no3hiPGjxeuK1AMRk9MdqqaAhTToVxztq1J8oGe5r
    ut7qOiiQH/WBimRnOK6LWrEandS6jb6lZrBKAR582xoeB8uDzx7VSh0yefBiikkUDJEalsflWNr9lqD/u4t
    OvCqjjEDHP6VDRc52V+pU8VXsGo67JLbyedEqJF5x480qoBb8TRT/FkXla+E8sIRbQZXbtwfLGePWiouzGK
    uj08+bu3q2+Nu1ORGVSWO0A5zT7aIwgANkE5+lLdxgqyyNw3TbSWh7V1flLVvKgXJxvxjPrQZE27W4Y+tUL
    eJo12liygfKT1qdVMqKGOGU8GnchwSegtwvlIJB9w9qbEuS/Hy+/UVO4O3Y5BHb2qsGKFg+QOmaECehKgZD
    mrauPNV+vFZV3dtDLGFG5G4q4j/ALtT69qL9DGpB2u+o2WF55CFYKAMk4yR9Ktw2McS/J8x9SaoC58mRsKS
    e+KmN0jr945rSNrHiYnmdR2LbsoGwtgj9agLRxkEsCKgk+cc1mXbPEWkVGYAgbF7jvUyehEY9zRunMhBAwB
    To5jHFk4FZ6THZ83QD+LrVC5vneTy4n2DHLCufmtqdSp3VjVM5uJOGI55FXFm2ng5GOmKxrJt2APuD+L1Na
    ahCQC2T14qVIJxSNaC9wqgDmpJ5ty7uRn1qrBESw+XAxVoQ/KOK6Ipvc5JNIW3OBz07VcSQdCetVSm0YPA+
    tQy3CqvUKR61pZIzbbeg/UbcXCjBxIvRqx443RsdCDyRU9xq0SsFQiWTPRatWUTXmGKbQahWex3U6zpx9/Y
    qJKygIevXnuK1bOT92quvXpzSyWQDLu5I6ZqYRBRyOlUomcsbF6JEc9ozoW27lBxkdq5fWbR0Ec0IAliOQT
    0PtXWxXRQnOCucj0rI1y6a6iMCqoibkqo6n1PvRJdDqw9Zya7EkN0l1axSjvwQP71TxLvc5GB2A71zdtMbR
    1WQ4zx7e1b1lcI0qE/zpRfQ0nDl1RZDAqeQAOBxUEuRllYbz09xU0+0tnoBVZ5FVOW78USJixrZYcHGOSPW
    p4ztXnimEocOhGcc471E0y7GI9KLDbuXYy4cMOvGKLyRwcLtdjyc9FxSRsCituwSOlZGrXywRsqsTjkg+tJ
    qwQi5S0IL+5XLmQ4A7f4VhRk3MmM4Qn05NR3Tz3lwiRI7s3LKvOB2FdBpekTZV5EEQx90nJqV7zOtyVOOpn
    z2wVAcHjiq8kQigYjKt2Oa6S9jWNACo4685Fcvrcu2NQpwC1W42RFOpzjBI8o27icDnNEUUhc4G4dxSQMI4
    wCPnb+dbNpEI4QX6nkmiKvuVOpy7GDqDFQFPQV0HhXH2Rtwzk9axtUhZ5gI1GzP3jWzoCeVGq5NL7YqjvTN
    6LCNnOSeBUoO9wB27VHImQCOlTrhEGT9K0OG5Lv2oNw4FVnlLZPalkkODk4Aqo8hI+U47GkVCI8ud+BURnG
    4hfvVFM5WM7TyelQooVep3N1NJs2UepIznOfzqwol2gqhI61AqFjuXOAauxTErsBIxS5Qk7LQrGSTJwm0ep
    oOGVt9STkbju5qpNIE7gCqSsZ77FWVlHYg9qx9RnABOanvbvLcdPWue1K4BVtx96pOwJMxtcuQc4bmuQu2C
    g56mtvWbjMKhTyx5rm7psk7ua5qjuxVJWVivIQaZZr5l1Eo6lqZIST1q1oif6crH+HmoW5zbs9J0pQIUX+6
    KdOGY7V6Umlj/Ri/rT7mdbZN7Efga7HsdVP3dWOl1a5023b7PdSwyMAD5bYyK56XxHrDybhql7jP/PU1bsH
    trldUv76FrqKzjUrbhioZmbALEfwinPYWWq6bNd6NAbe7gUvcWIYuCn9+MnnjuKzkzKUueRkvcT3k5mupXm
    lbALuckgdOaK2vENrBaaz5VtGscXkQsFHTJQEn86KzN4x0PRJDKkgAyR61cdwIxnDNjgUy2XMbOxBz2x0qF
    iu5TyG6c0rnr2bfoSwu56DAB5HpSyvknBwRVectvxGxUdznrUpaN1wGAkHpTuJx6k3m7uQCcUSEEA5yDVRS
    6yEhsJjnPSnxKdpZiNgPAppkyikrkFxKBJt7HgU+SaRVA3YXHOOwpLVBNO5PQdKdKoMTrjJzVKPU5atS3ul
    6NYms2nUqY1IQnPzZPt6VAwA5HIrFVPNIRGdSDksOv0rZ0yzJdWZ5GA/vGk5dDyWnHVliOOXqqMamezubgB
    fJ2jPXOK3bSFAnQZA9KvRoCPl5zVKJyyxFnocRdaBeuCEKKuPzrNk0S7tuZIiy+o6V6TOnlqdwOR71SeQY+
    bGPzrN4dS1uaRxsuxw9raTzTeWEZF6lj0FdLp+mJCvyjLdS3rVoeUrk4BatXw9cWo1ONrtkWIfMQ3Q/WiFJ
    Q1ZNXEOexFbaZNIu5EIQDLHHQVFKY4N6t82O9eh6zqVta+H5rwhNjjYvlEHINePy3LXbSOzFY8nAFaKVzCM
    HLcZqWqLEpCZY+grlru/nuptu5sHgLVjVJt8oigGWJxxU2n2BhAkddznnntWUpOWiO+EY01cm0mx8raXxuP
    U111o8cceOhArEgIUds9qmM+3vWsUoo5KzdR3Zo3F0Ac56VH9rG3jnPU1jyXLSHCnJpSzIASa1TM/Z2NVJV
    kTkbfaqMsaGXcOCf1qjJelTkt+FVptTXzBszkd6zqNI68PeLJNSttzgKOadbI6dXyQaqfbGd9znntUsE25g
    SazTXQ6p4mXLaJu2wMwCsx9qdNpcpTKvz6VmJqSwDC4LVah1OefG1vlrS6tqcqqVk7pmbNJNDI0bZDenrUE
    NwS5L84HStaeMXD7nHPqBUDaU6hjH0Iz0qLu56MMRBrXcil1LagCnBAx1rkby6m1C8CKrC33/M3862Nds5o
    ogCCCxxn0pt1EI9MWOMKAvIx1P1pSTkrG8HGGq6nV6VHDa2yrbouABnjtU73DPu28A+tY+gXourOPkBiNp/
    DtWoxVcADLA9a2jZrQ8+ouWTvqErIIyrKCD96uL12OMX0Sq37oZJ4rprqZwWUL8oGSe9cfrDEXT88BelFTR
    G+G0kX9Hh+03LXDj9ynyoD/ABGthju3BAMDtWdpUoi0qIqQSFqxaSF4gehYZpRVkVJc0mxs9uEVXyeBjPp+
    FWNNlAbngiqd2zLGVYnNQ6S4uLtgSNgOKmW5so80NTro7jzV2xj5R39aldhjBPIHNVYWCKFQAU55cdfx96s
    5OUdI/bqvrVWV+efzpXcFvaq0rlhjoexqWzWMRHcPMFHYc1ImScg8VWORwv3vWpY8JjDfnU3NGrFkuFQ/N+
    FRR3A3HNVr2chTgDOOtUUuPlzkZqxKF1dmrNONpway7y56j+dRTXRwMMAT6Vk3V2SDu6D9aZCjYivLjHoK5
    7ULseW3PPtVm+uutc1qV1w3TNROVkJuxT1Kcs4G7oKyJW9+akmlLNzVOVySelc7ZzTlcQvk+9amhRNJKqqM
    u1ZKAuwVeSe1eieENIWKNZpR8+AaqEW2RTV2bUKC2sVZ8ZA5rk9Y1BppSsZzzjFani3VRCDBEQWI7Vh6ZZs
    7CSUElugrpkypScpckTX8Mx6rbzvPpEMksgXbKqx+YrKezL0Iq7aaPrtpdpc2+n38U6NuV0iIwf8AD2qTRp
    7jTb+Ke0DFwdrRjOJF7qR71PqMGso0ksNvqkMBJKqS7bR6ZrORvCHKUdbnvrnVnfU4jDdlUDrs2HAGAcduK
    KoKZ3kaW4lZ2/vOST+dFJRNLnrce1CFycA1GSkytgkEHjFP2Kyq4fnGDUYi2lmU9azSuexZXuNeKRXD/eU8
    Y9KaQkfKn5j1zUi7kjbzGzmo51Gwhvwp2He5IAJF8thwe4qSNQiNGMjjio7cKigk8GpZCrRv5TDjqTVbGNT
    qhNOBXO4nk557e1aEeniVQzXEUSyMR8x+77msyxJVmYng9qZeXO1XUHrxW3Q8is3eyHRRCOYqGDfN1A4xW9
    YL0wMiubsXBbOeK6XT3G0YNYxtucdZuxswfLwPxqdSQeOlVIpMqOalMoA61see1c6iyhstS0WczMsV3ECQ2
    eo7Vwd/cBGYKcgelT3tyVRgGI4rmru53FuaynLlOilTuXPtJeTAq3bLubPBrCspgZ2OeOldHZsuwkdKdOXM
    rlVY8uxbeMNCFYttHOM9Koy2mVIC/KfetBGHA7VK4BTPatGrnPGo4nGy6dHBcB0BDZ71baQRp196u3yBst3
    9vSsO73RxMVY5J6Vk42OpS5+pM9yBk81CJmkOGPy1UQuwG4kt6Vo6dZy3k8cMCFnc4A9KI3ZTtEdbISQo5y
    aZfzeWMMcEV0PifSB4ZtojcyRtcyrwic15vqV3NI/IOD3xVSnyq6Ipx53dlqW73sQrZNQiTbVWCNkj3HOT6
    0kjnjJArmlNs7VFLQueaScnNWopyig1n2zKz4c4GKJHwcA8VEZCUbstpKXlz1zWxYblHUCsGwO6SugtBvdQ
    o5PFPmIqaI2rTnbkDBrZs0DYFQ6fafIuev0rYt4AvIHFbRT6nBOWuhFcadDcIVlUEfSuL8S6YLRsxD5DwK9
    BbjHpWXr9kt1ZPt5YdK1iOjWlTmrvQ8v0Wf7LdyxnhS24V0/2lSgIPX061x94jW1/hgc961dPvVZSp6gY4q
    qbtdHr1oc3vIt305C7ORnnrya5O+Hm3MmOAeK2tQlbDMcZP8qwostMeeetFTsaUFbU1YZBFYrGOmPxq9C5j
    A+nFZmSzIuOnJ960VIIGeooRp0EvPmiPQUaMqRMWJ+YjHNQ3kpUBcdafbsoKZBpW94tfDY3VmIxjtxTZZuD
    VMSjuai8/J75qjLl1LjOcZ3U3zecCqUkxZgAenWlWTB65NRuy1EvLIFU55PY1A8xLe/eqzTYPWq8k4AY5xR
    YIos3EgVTu
    rNkuApJqC8vNsbc81jyXZ7mhsLaGncTk5wRisa+u8bsdqgubzCnmsW9u8luevvRKVjFuw69vCSRmsC+myWw
    afcT5Y81nzvubrxWEnc5pzuM3+tQk5YgetOJwfWui8K6KbyZZpl/dj9aSTkYpOTsWfCegvKwuJhx2FdVrF/
    HpdmUQgyEYGKsXFzDptoTwuBhRiuZjhl1S8M02dgORXXGKgvM1bcfchuypp9nLeTmefJJOQK6a1tVjUcVPZ
    2qxoAFPtirbx7OtFrm9Kiqa1LegExLfpbzxwahLEBbyOQo6/MAx6EjvVNbLxWLoOs9xER/y1e7G0e5O6o7K
    O1uEv7m/R5ra0RT5MbbS7M2Bk9hUd7p1neabNe6IkiNAN1xZu+8ov8AfQ919fSoa1CTu9Cl4vuIZtalNs8c
    mVQSSRDCvIFG9l9iaKb4msYLPVzFbII4vIifbnPLICT+dFCJTPR2i5G1ug596jd5EjAUfNnvSgMr4B4AzUK
    zOzMHUjbWC0PoLdi6r5jUOAxxzUFy+G570zZk7yx+lTzFPLUsBn1q0ZOyehBuCKpc4HaoYnw8qZ5NR3LB9q
    g5Uc0iMgKkkbv50K7ZNRpRJxN5RBPTHNZM9yTMx7fWjUpmUsR3OBWRJORL3CnsadSVlY8l6s6KwmO7g9K6W
    xn+UVw9nN710VlcisozsYVadzqoZ6e04B6gmsSO6UYwf1p/2gsOGOB1Na85yOlqS6jcYVvpXM3k7YOOa076
    X5SS2B6kVzV1cquecnPB7Vz1pnXRpGjZSthQRhicmunsZiFHPykdK4exn7k5OetdNZTjYOa0oy90zrw1Okj
    lB5BzTmuMKQeayo5+2aV7gevNdSZwchLcSj6Cse62/Nk5z+lT3VyMGsG8ugW4Y46VE5pG9Omyw06x8LzUtj
    rtzp8u+0YB/U9qwGufm46U6MkjPY1nGd9jf2Sa1Na91G61CdprqV5JG43Mc1C6YUbueKrRNjPNLJMSCM8Ct
    tLEWfQJyAp6dO1ZjuCeamlkGD1rNllx0rlrM2gu5eLIQCnBpGfJGKpxvkZyangGXGScZrnvY3SsrmxYrtAw
    Mk8V2vhzTHwskufoRXP+GbJrm6VsYUcjNel2cKwxhQK1pxvqcGKq8vuont4NoH+FXY129cYp1vEGAOeMUTD
    b05FdJ50pMguwFTK9agj/AHsJB6GrE43R9BUFiMZXHFNaCT0PN/G2mfZrwzopAIya5KK42TBQeT/OvZPE1g
    tzZuNuTg4rxC6H2fV/LfG5Sc4pXse9g6ntYW7GpqEpEIGen61WtkKrvP3j2NMkk81yx+6P51IkhHIODVt3Z
    1RVlYmifMhfnFX1kIjcnBOOtZ8bBFIJGTU5JVAB0pp2NNxJHIbJIJPf2qa3fsDxjms6Zj5g54FW43XAI4I7
    VN9S7aFuWbb93kVEsuGIBqvJJzmlRtsOT1p3BKxNDJudjT3k71mxXIJOKGnBznFIUtyxNcHJHaqs0+1SxPz
    dlqCW4AGc49BVCecEZZse1BNxL+6OwknkVjyXLMc5pmp3G7IDY9vWsyWfaMdKzctSJ1NNCe5usDisqefJ96
    ZNPkHFUpJRzUSZxzmwkl5JqEnJpC2etTWVs93OscYJJOOKlamDbb0LeiabJqNyFUHYDycV6TEsOlWYXgbR0
    9araRZwaRYgsF8w+lQPHLqU+58iMV1U48qubxi4Ky3ZVkWTVrkO+RED0rdtLZYkUL06Yp9narCqhVGKu7Mc
    8Ypt3Z1UaCgrvcQeXEuehrG1TUVDbV/nVjUpiikA84rnZEeSU55obsEpdi9pmq3WnzvNbhHWRdkkci7kdfQ
    iiwv57S8W4tpfKmUkgjpz1GO49q0vDWmiUyTTwGZIyiRw7sCWRzhVJ9OpP0rVjkN1e3No6abcRRBisSQBBN
    t5IRgMg4BwT1xUmTsjndYupdUvWu51jSR1VSIxhflGOlFWNVtEtbwxwMzwuqyxM3UowyM+/Y/SitUlYwbOy
    nuhHIDk46UskgADdutVE5dM880+b+KuNbn1LilYn+1ZAwB5fcmqV1dtK+2Nhspl7xAMeoqG2+9+NDetibJa
    li3csSHyAKkl2qob+LtTH4qK8+4PxrVLQ4q0nuinezedcDnO3PAPeqlyqscDj3FSsAJCQOc1F2NaVErHlQf
    vDoMoODWrayvxis2CtK36iuNQubNaGjCxONz9KtfaQoIDce1ZsXf60HvWkUT7Nbli8ujIpHoK5u+XdllJIz
    3rUl/1jVmv0f8AGnOKa1NqcUiHT3KFsng10Vlc4AyRzXMx/eP0rUtv9XXPB2Ma8UdLHPgdaSW4+Xk9PSsyM
    n1olJ3Cum5w8quJd3Xygg4zWLcykkknipZiSGyf4qqXHSuWpJnRTSAPwOatQygADvWd6fjUx/1o+laUtkVI
    vNLjnIqtLOVzz3qJu9Qz9K1cmYpahcT7+M/lVMsW4zRP/D9Khj6j61hUdy4mhDkAAVqWEDSOECncfQVQUDK
    f7orvPCCI0eWVSfUis+ppN2R0nhuw+z264XBx36100MbnGRzTLADy14HStSL7x+ldETx6msm2RJHIp60rhu
    M/nV1un4VDL90VojGSuV3AERz1FV7QYlarQ+6/0qtB/rm+tUZxJbqJXRgecivE/HGlta6z5qriNs5OK9yk/
    wBXXnXxIVTbqSozn0pbno4CbjUsjzPJwfanI7F8fy70yXqfpSx/d/CrPbWpdDAoMkZ+lTrJ+7A4Jx0qgvUV
    cf8Ah+lNFWsyGUMRlQSajaYovPGBVlf9V+dZ91/q5PrUy01Lpu5OspkIAJx1qS4n2wt06VVg+6tRX33V+tF
    9BsdDuEYZjyajmm2jgilfoPpVMffajYzkxZJgAWY5PpWfdXPUmpbj79ZV52+tDdjCTKt3MXbCdKz5n5O5+n
    arN7xE2OOKy7j7prFnNOTGyTDnbgVXcg0j9aav3fxqXuYSZLDC8zBVBJJwK7nw/pyafbiWVQZSOM1g+GADd
    jIB6118n+tUds1tSima0Y6cxPFDLdPuk4QdBWpBAEAA7UQf6tPpVxei1szspRS1ESLHJqK6cRqcnmrZ6Vja
    t1oSCc2ULo+a5OTUccWD0yaPWljPLVPUyNzRb1IDJDPIYUkKskoXPlyKcqxHcdQfrWi8MUUklxs020MikNd
    RXJl2hupjj6hjzjPSuZ7p9RUkg+eX6VSVyJok1OVLu9aSJCkKqscSHqEUYGff1oqOPoaKpGLR/9k=);\">"
    ,
    " </div>",
    " <div class=\"lgnd\">",
    " A large, white plaque is present on the oral mucosa. White sponge nevi
    represent a rare genetic condition caused by mutations in keratin 4 or keratin 13
    genes. Lesions usually first appear during childhood.",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " Image created by Carl Allen, DDS, MSD. Reproduced with permission from:
    www.visualdx.com. Copyright Logical Images, Inc.",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6356=[""].join("\n");
    var outline_f6_13_6356=null;
    var title_f6_13_6357="Ethambutol: Pediatric drug information";
    var content_f6_13_6357=[" <noscript>",
    " <div id=\"javascriptDisabled\">",
    " It seems to us that you have your JavaScript turned off on your browser.
    JavaScript is required in order for our site to behave correctly. Please enable
    your JavaScript to continue use our site.",
    " </div>",
    " </noscript>",
    " <div id=\"printHeader\">",
    " <div id=\"printHeaderLogo\">",
    " <img alt=\"UpToDate\" src=\"./../images/UTD2_masthead.myextg\">",
    " <img align=\"right\" alt=\"Wolters Kluwer Health\" height=\"40\"
    src=\"./../images/logoWKH.myextg\" width=\"175\">",
    " <br>",
    " <div id=\"printHeaderText\">",
    " Official reprint from UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " <br>",
    " <a href=\"file://www.uptodate.com\">",
    " www.uptodate.com",
    " </a>",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </br>",
    " </div>",
    " </br>",
    " </img>",
    " </img>",
    " </div>",
    " <div id=\"printHeaderLinks\">",
    " <a class=\"TOPIC\" href=\"#\" id=\"printHeaderPrint\" rel=\"3\" title=\"Click
    here to print\">",
    " Print",
    " </a>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a href=\"#\" id=\"printHeaderBack\" title=\"Back to normal view\">",
    " Back",
    " </a>",
    " </div>",
    " </div>",
    " <!-- TC:TOPIC_PAGE -->",
    " <div id=\"topicContent\">",
    " <div id=\"drugTitle\">",
    " Ethambutol: Pediatric drug information",
    " </div>",
    " <div id=\"lexiTitleImg\">",
    " <img height=\"17\" src=\"./../images/lexiComp/Lexicomp_2012_71x17.myextg\"
    width=\"71\"/>",
    " </div>",
    " <div class=\"clear\">",
    " </div>",
    " <div id=\"drugCopy\">",
    " Copyright 1978-2013 Lexicomp, Inc. All rights reserved.",
    " </div>",
    " <div id=\"topicText\">",
    " (For additional information",
    " <a class=\"drug drug_general\" href=\"UTD.htm?12/7/12406?source=see_link\">",
    " see \"Ethambutol: Drug information\"",
    " </a>",
    " and",
    " <a class=\"drug drug_patient\" href=\"UTD.htm?7/56/8068?source=see_link\">",
    " see \"Ethambutol: Patient drug information\"",
    " </a>",
    " )",
    " <br/>",
    " For abbreviations and symbols that may be used in Lexicomp (",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?23/39/24183\">",
    " show table",
    " </a>",
    " )",
    " <div class=\"list ubnlist drugH1Div drugBrandNames\" id=\"F168048\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Brand Names: U.S.",
    " </span>",
    " <ul>",
    " <li>",
    " Myambutol&reg;",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"list cbnlist drugH1Div drugBrandNames\" id=\"F168049\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Brand Names: Canada",
    " </span>",
    " <ul>",
    " <li>",
    " Etibi&reg;",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"list_set htclist drugH1Div drugBrandNames\" id=\"F1047287\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Therapeutic Category",
    " </span>",
    " <ul>",
    " <li>",
    " <span class=\"list-set-name\">",
    " Antitubercular Agent",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"block dos drugH1Div\" id=\"F1047281\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Dosing: Usual",
    " </span>",
    " <p>",
    " (For additional information",
    " <a class=\"drug drug_general\" href=\"UTD.htm?12/7/12406?source=see_link\">",
    " see \"Ethambutol: Drug information\"",
    " </a>",
    " )",
    " </p>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Oral:",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Infants and Children:",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Tuberculosis, active:",
    " <b>",
    " Note:",
    " </b>",
    " Used as part of a multidrug regimen; treatment regimens consist of an initial
    2-month phase, followed by a continuation phase of 4 or 7 additional months;
    frequency of dosing may differ depending on phase of therapy",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:6em;text-align:justify;\">",
    " HIV negative: 15-20 mg/kg/day once daily (maximum: 1 g/day)",
    " <b>",
    " or",
    " </b>",
    " 50 mg/kg/dose twice weekly (maximum: 2.5 g/dose) (",
    " <i>",
    " MMWR",
    " </i>",
    " , 2003)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:6em;text-align:justify;\">",
    " HIV-exposed/-infected: 15-25 mg/kg/day once daily (maximum: 2.5 g/day) (CDC,
    2009)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " MAC, secondary prophylaxis or treatment in HIV-exposed/-infected: 15-25
    mg/kg/day once daily (maximum: 2.5 g/day) with clarithromycin (or azithromycin)
    with or without rifabutin (CDC, 2009)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Nontuberculous mycobacterial infection: 15-25 mg/kg/day once daily (maximum:
    2.5 g/day)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Adolescents and Adults:",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Disseminated",
    " <i>",
    " Mycobacterium avium",
    " </i>",
    " (MAC) treatment in patients with advanced HIV infection: 15 mg/kg ethambutol
    in combination with clarithromycin or azithromycin with/without rifabutin
    (Griffith, 2007)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Nontuberculous mycobacterium (",
    " <i>",
    " M. kansasii",
    " </i>",
    " ): Adults: 15 mg/kg/day ethambutol for duration to include 12 months of
    culture-negative sputum; typically used in combination with rifampin and
    isoniazid;",
    " <b>",
    " Note:",
    " </b>",
    " Previous recommendations stated to use 25 mg/kg/day for the initial 2 months
    of therapy; however, IDSA guidelines state this may be unnecessary given the
    success of rifampin-based regimens with ethambutol 15 mg/kg/day or omitted
    altogether (Griffith, 2007)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Tuberculosis, active:",
    " <b>",
    " Note:",
    " </b>",
    " Used as part of a multidrug regimen; treatment regimens consist of an initial
    2-month phase, followed by a continuation phase of 4 or 7 additional months;
    frequency of dosing may differ depending on phase of therapy.",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Initial: 15 mg/kg once daily; Retreatment (previous antituberculosis
    therapy): 25 mg/kg once daily",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Suggested doses by lean body weight (",
    " <i>",
    " MMWR",
    " </i>",
    " , 2003):",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:6em;text-align:justify;\">",
    " <i>",
    " Daily therapy:",
    " </i>",
    " 15-25 mg/kg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 40-55 kg: 800 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 56-75 kg: 1200 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 76-90 kg: 1600 mg (maximum dose regardless of weight)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:6em;text-align:justify;\">",
    " <i>",
    " Twice weekly directly observed therapy (DOT):",
    " </i>",
    " 50 mg/kg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 40-55 kg: 2000 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 56-75 kg: 2800 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 76-90 kg: 4000 mg (maximum dose regardless of weight)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:6em;text-align:justify;\">",
    " <i>",
    " Three times/week DOT:",
    " </i>",
    " 25-30 mg/kg (maximum: 2.5 g)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 40-55 kg: 1200 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 56-75 kg: 2000 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:8em;text-align:justify;\">",
    " 76-90 kg: 2400 mg (maximum dose regardless of weight)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " <b>",
    " Dosing interval in renal impairment:",
    " </b>",
    " Aronoff, 2007:",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Cl",
    " <sub>",
    " cr",
    " </sub>",
    " 10-50 mL/minute: Administer every 24-36 hours",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Cl",
    " <sub>",
    " cr",
    " </sub>",
    " &lt;10 mL/minute: Administer every 48 hours",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Hemodialysis: Slightly dialyzable (5% to 20%); Administer dose postdialysis",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Peritoneal dialysis: Dose for Cl",
    " <sub>",
    " cr",
    " </sub>",
    " &lt;10 mL/minute: Administer every 48 hours",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Continuous arteriovenous or venovenous hemofiltration: Dose for Cl",
    " <sub>",
    " cr",
    " </sub>",
    " 10-50 mL/minute: Administer every 24-36 hours",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " <i>",
    " MMWR",
    " </i>",
    " , 2003: Adults: Cl",
    " <sub>",
    " cr",
    " </sub>",
    " &lt;30 mL/minute and hemodialysis: 15-25 mg/kg/dose 3 times weekly",
    " </p>",
    " </div>",
    " <div class=\"block foc drugH1Div\" id=\"F168024\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Dosage Forms: U.S.",
    " </span>",
    " <p style=\"text-indent:0em;text-align:justify;display:inline\">",
    " Excipient information presented when available (limited, particularly for
    generics); consult specific product labeling.",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Tablet, oral, as hydrochloride: 100 mg, 400 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Myambutol&reg;: 100 mg",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Myambutol&reg;: 400 mg [scored]",
    " </p>",
    " </div>",
    " <div class=\"block geq drugH1Div\" id=\"F168009\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Generic Equivalent Available: U.S.",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Yes",
    " </p>",
    " </div>",
    " <div class=\"block adm drugH1Div\" id=\"F1047290\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Administration",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Oral: Administer with or without food; if GI upset occurs, administer with
    food. Tablet may be pulverized and mixed with apple juice or apple sauce. Do not
    mix with other juices or syrups since they do not mask ethambutol's bitter taste or
    are not stable. Administer ethambutol at least 4 hours before aluminum hydroxide.",
    " </p>",
    " </div>",
    " <div class=\"block sta drugH1Div\" id=\"F1047283\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Stability",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Store tablets at controlled room temperature 20&deg;C to 25&deg;C (68&deg;F
    to 77&deg;F)",
    " </p>",
    " </div>",
    " <div class=\"block use drugH1Div\" id=\"F1047289\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Use",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Treatment of pulmonary tuberculosis (FDA approved in ages &ge;13 years and
    adults) and other mycobacterial diseases in conjunction with other
    antimycobacterial agents",
    " </p>",
    " </div>",
    " <div class=\"block mst drugH1Div\" id=\"F168094\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Medication Safety Issues",
    " </span>",
    " <div class=\"collapsible\">",
    " <span class=\"collapsible-title\">",
    " Sound-alike/look-alike issues:",
    " </span>",
    " <div class=\"collapsible-wrap\">",
    " <p style=\"text-indent:-2em;margin-left:4em;text-align:justify;\">",
    " Myambutol&reg; may be confused with Nembutal&reg;",
    " </p>",
    " </div>",
    " </div>",
    " </div>",
    " <div class=\"block arm drugH1Div\" id=\"F168092\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Adverse Reactions",
    " </span>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Cardiovascular: Myocarditis, pericarditis",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Central nervous system: Confusion, disorientation, dizziness, fever,
    hallucinations, headache, malaise",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Dermatologic: Dermatitis, erythema multiforme, exfoliative dermatitis,
    pruritus, rash",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Endocrine &amp; metabolic: Acute gout or hyperuricemia",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Gastrointestinal: Abdominal pain, anorexia, GI upset, nausea, vomiting",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Hematologic: Eosinophilia, leukopenia, lymphadenopathy, neutropenia,
    thrombocytopenia",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Hepatic: Hepatitis, hepatotoxicity (possibly related to concurrent therapy),
    LFTs abnormal",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Neuromuscular &amp; skeletal: Arthralgia, peripheral neuritis",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Ocular: Optic neuritis; symptoms may include decreased acuity, scotoma, color
    blindness, or visual defects (usually reversible with discontinuation, irreversible
    blindness has been described)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Renal: Nephritis",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Respiratory: Infiltrates (with or without eosinophilia), pneumonitis",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Miscellaneous: Anaphylaxis, anaphylactoid reaction; hypersensitivity syndrome
    (cutaneous reactions, eosinophilia, and organ-specific inflammation)",
    " </p>",
    " </div>",
    " <div class=\"block coi drugH1Div\" id=\"F1047293\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Contraindications",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Hypersensitivity to ethambutol or any component; optic neuritis, unless
    clinical judgment determines that it may be used; use in patients unable to discern
    and report visual changes (eg, very young, unconscious patients)",
    " </p>",
    " </div>",
    " <div class=\"block pre drugH1Div\" id=\"F1047280\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Precautions",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Use with caution in patients with ocular defects or impaired renal function;
    modify dose in patients with renal impairment",
    " </p>",
    " </div>",
    " <div class=\"block war drugH1Div\" id=\"F1047279\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Warnings",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Optic neuropathy including optic neuritis or retrobulbar neuritis
    characterized by decreased visual acuity, scotoma, color blindness, and/or visual
    defect has been reported with ethambutol therapy and may be related to dose and
    treatment duration; irreversible blindness has also been reported. Loss of visual
    acuity is generally reversible when ethambutol is discontinued promptly, but
    reversal may require up to a year. Some patients have received ethambutol again
    after such recovery without recurrence of visual acuity loss. Use only in children
    whose visual acuity can accurately be determined and monitored; fatal
    hepatotoxicity has been reported; not recommended for use in children &lt;13 years
    of age unless benefit outweighs risk of therapy",
    " </p>",
    " </div>",
    " <div class=\"block cyt drugH1Div\" id=\"F13299290\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Metabolism/Transport Effects",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " None known.",
    " </p>",
    " </div>",
    " <div class=\"block dri drugH1Div\" id=\"F168018\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Drug Interactions",
    " </span>",
    " <br/>",
    " <br/>",
    " <div class=\"lexi\" id=\"lexiInteractAddInfo\">",
    " (For additional information:",
    " <a class=\"dip\" href=\"./drug-interaction\" target=\"_blank\">",
    " Launch Lexi-Interact&trade; Drug Interactions Program",
    " </a>",
    " )",
    " </div>",
    " <div class=\"lexi\" id=\"lexiInteractImgB\">",
    " <img border=\"0\" height=\"17\"
    src=\"./../images/lexiComp/Lexicomp_2012_71x17.myextg\" width=\"71\"/>",
    " </div>",
    " <div class=\"clear\">",
    " </div>",
    " <p style=\"text-indent:-2em;margin-left:2em;\">",
    " Aluminum Hydroxide: May decrease the absorption of Ethambutol.",
    " <i>",
    " Risk D: Consider therapy modification",
    " </i>",
    " </p>",
    " </div>",
    " <div class=\"block prf drugH1Div\" id=\"F168020\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Pregnancy Risk Factor",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " C (",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?16/42/17068\">",
    " show table",
    " </a>",
    " )",
    " </p>",
    " </div>",
    " <div class=\"block pri drugH1Div\" id=\"F168033\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Pregnancy Implications",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Teratogenic effects have been seen in animals. There are no adequate and
    well-controlled studies in pregnant women; there have been reports of ophthalmic
    abnormalities in infants born to women receiving ethambutol as a component of
    antituberculous therapy. Use only during pregnancy if benefits outweigh risks.",
    " </p>",
    " </div>",
    " <div class=\"block mop drugH1Div\" id=\"F1047286\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Monitoring Parameters",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Monthly examination of visual acuity and color discrimination in patients
    receiving &gt;15 mg/kg/day; periodic renal, hepatic, and hematologic function
    tests",
    " </p>",
    " </div>",
    " <div class=\"block pha drugH1Div\" id=\"F1047278\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Mechanism of Action",
    " </span>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Inhibits arabinosyl transferase resulting in impaired mycobacterial cell wall
    synthesis",
    " </p>",
    " </div>",
    " <div class=\"block phk drugH1Div\" id=\"F1047292\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Pharmacokinetics (Adult data unless noted)",
    " </span>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Absorption: Oral: &sim;80%",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Distribution: Well distributed throughout the body with high concentrations
    in kidneys, lungs, saliva, and red blood cells; concentrations in CSF are low;
    crosses the placenta; excreted into breast milk",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Protein binding: 20% to 30%",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Metabolism: 20% by the liver to inactive metabolite",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Half-life: 2.5-3.6 hours (up to 7 hours or longer with renal impairment)",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Time to peak serum concentration: Within 2-4 hours",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Elimination: &sim;50% in urine and 20% excreted in feces as unchanged drug",
    " </p>",
    " <p style=\"text-indent:-2em;margin-left:2em;text-align:justify;\">",
    " Dialysis: Slightly dialyzable (5% to 20%)",
    " </p>",
    " </div>",
    " <div class=\"block pai drugH1Div\" id=\"F1047285\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Patient Information",
    " </span>",
    " <p>",
    " (For additional information",
    " <a class=\"drug drug_patient\" href=\"UTD.htm?7/56/8068?source=see_link\">",
    " see \"Ethambutol: Patient drug information\"",
    " </a>",
    " )",
    " </p>",
    " <p style=\"text-indent:0em;display:inline\">",
    " Report to physician any visual changes, numbness or tingling in hands or
    feet, rash, fever, and chills",
    " </p>",
    " </div>",
    " </div>",
    " <div id=\"topicAgreement\">",
    " Use of UpToDate is subject to the",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_in_page\"
    target=\"_blank\">",
    " Subscription and License Agreement",
    " </a>",
    " .",
    " </div>",
    " <div class=\"headingAnchor\" id=\"references\">",
    " <h1>",
    " REFERENCES",
    " </h1>",
    " <ol id=\"reference\">",
    " <li>",
    " <div class=\"reference\">",
    " American Academy of Pediatrics, Committee on Infectious Diseases,
    &ldquo;Chemotherapy for Tuberculosis in Infants and Children,&rdquo;",
    " <i>",
    " Pediatrics",
    " </i>",
    " , 1992, 89(1):161-5.",
    " <span class=\"pubmed-id\">",
    " [PubMed",
    " <a href=\"UTD.htm?6/13/6357/abstract-text/ 1728006 /pubmed\" id=\"
    1728006 \" target=\"_blank\">",
    " 1728006",
    " </a>",
    " ]",
    " </span>",
    " </div>",
    " </li>",
    " <li>",
    " <div class=\"reference\">",
    " American Thoracic Society, CDC, and Infectious Diseases Society of
    America, \"Treatment of Tuberculosis,\"",
    " <i>",
    " MMWR Recomm Rep",
    " </i>",
    " , 2003, 52(RR-11):1-77.",
    " <span class=\"pubmed-id\">",
    " [PubMed",
    " <a href=\"UTD.htm?6/13/6357/abstract-text/12836625/pubmed\" id=\"12836625\"
    target=\"_blank\">",
    " 12836625",
    " </a>",
    " ]",
    " </span>",
    " </div>",
    " </li>",
    " <li>",
    " <div class=\"reference\">",
    " Aronoff GR, Bennett WM, Berns JS, et al,",
    " <i>",
    " Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and
    Children",
    " </i>",
    " , 5th ed. Philadelphia, PA: American College of Physicians, 2007.",
    " </div>",
    " </li>",
    " <li>",
    " <div class=\"reference\">",
    " Centers for Disease Control and Prevention (CDC), \"Guidelines for the
    Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-
    Infected Children,\"",
    " <i>",
    " MMWR Recomm Rep",
    " </i>",
    " , 2009, 58(RR-11):1-166. Available at",
    " <a href=\"file://aidsinfo.nih.gov/contentfiles/Pediatric_OI.pdf%20\"
    target=\"_blank\">",
    " file://aidsinfo.nih.gov/contentfiles/Pediatric_OI.pdf",
    " </a>",
    " <span class=\"pubmed-id\">",
    " [PubMed",
    " <a href=\"UTD.htm?6/13/6357/abstract-text/19730409/pubmed\" id=\"19730409\"
    target=\"_blank\">",
    " 19730409",
    " </a>",
    " ]",
    " </span>",
    " </div>",
    " </li>",
    " <li>",
    " <div class=\"reference\">",
    " Graham SM, Bell DJ, Nyirongo S, et al, \"Low Levels of Pyrazinamide and
    Ethambutol in Children With Tuberculosis and Impact of Age, Nutritional Status, and
    Human Immunodeficiency Virus Infection,\"",
    " <i>",
    " Antimicrob Agents Chemother",
    " </i>",
    " , 2006, 50(2):407-13.",
    " <span class=\"pubmed-id\">",
    " [PubMed",
    " <a href=\"UTD.htm?6/13/6357/abstract-text/16436690/pubmed\" id=\"16436690\"
    target=\"_blank\">",
    " 16436690",
    " </a>",
    " ]",
    " </span>",
    " </div>",
    " </li>",
    " <li>",
    " <div class=\"reference\">",
    " Griffith DE, Aksamit T, Brown-Elliott BA, et al, \"An Official ATS/IDSA
    Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial
    Diseases,\"",
    " <i>",
    " Am J Respir Crit Care Med",
    " </i>",
    " , 2007, 175(4):367-416.",
    " <span class=\"pubmed-id\">",
    " [PubMed",
    " <a href=\"UTD.htm?6/13/6357/abstract-text/17277290/pubmed\" id=\"17277290\"
    target=\"_blank\">",
    " 17277290",
    " </a>",
    " ]",
    " </span>",
    " </div>",
    " </li>",
    " <li>",
    " <div class=\"reference\">",
    " Hill S, Regondi I, Grzemska M, et al, \"Children and Tuberculosis Medicines:
    Bridging the Research Gap,\"",
    " <i>",
    " Bull World Health Organ",
    " </i>",
    " , 2008, 86(9):658.",
    " <span class=\"pubmed-id\">",
    " [PubMed",
    " <a href=\"UTD.htm?6/13/6357/abstract-text/18797634/pubmed\" id=\"18797634\"
    target=\"_blank\">",
    " 18797634",
    " </a>",
    " ]",
    " </span>",
    " </div>",
    " </li>",
    " <li>",
    " <div class=\"reference\">",
    " Starke JR and Correa AG, &ldquo;Management of Mycobacterial Infection and
    Disease in Children,&rdquo;",
    " <i>",
    " Pediatr Infect Dis J",
    " </i>",
    " , 1995, 14:455-70.",
    " <span class=\"pubmed-id\">",
    " [PubMed",
    " <a href=\"UTD.htm?6/13/6357/abstract-text/7667049/pubmed\" id=\"7667049\"
    target=\"_blank\">",
    " 7667049",
    " </a>",
    " ]",
    " </span>",
    " </div>",
    " </li>",
    " </ol>",
    " </div>",
    " <div id=\"topicVersionRevision\">",
    " Topic 13286 Version 32.0",
    " </div>",
    " </div>",
    " <div id=\"footer\">",
    " <div id=\"supportFooter\">",
    " <span class=\"sfInfo\">",
    " &copy; 2013 UpToDate, Inc. All rights reserved.",
    " </span>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_footer\">",
    " Subscription and License Agreement",
    " </a>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Release: 21.6- C21.56",
    " </span>",
    " <br/>",
    " <span class=\"sfInfo\">",
    " Licensed to:",
    " <span class=\"emphasis\">",
    " AsanBook Dig. Med. Lib.",
    " </span>",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Support Tag: [0502-1.234.2.38-DECD7EA589-S244013.14]",
    " <br/>",
    " </span>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6357=[""].join("\n");
    var outline_f6_13_6357=[" <div id=\"toggleOutline\">",
    " <a href=\"#\" title=\"Collapse Topic Outline\">",
    " <img alt=\"\" src=\"./../images/orange_arrow_left.myextg\"/>",
    " </a>",
    " </div>",
    " <div id=\"innerOutline\">",
    " <h1>",
    " TOPIC OUTLINE",
    " </h1>",
    " <div id=\"outline\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168048\">",
    " Brand Names: U.S.",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168049\">",
    " Brand Names: Canada",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047287\">",
    " Therapeutic Category",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047281\">",
    " Dosing: Usual",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168024\">",
    " Dosage Forms: U.S.",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168009\">",
    " Generic Equivalent Available: U.S.",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047290\">",
    " Administration",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047283\">",
    " Stability",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047289\">",
    " Use",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168094\">",
    " Medication Safety Issues",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168092\">",
    " Adverse Reactions",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047293\">",
    " Contraindications",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047280\">",
    " Precautions",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047279\">",
    " Warnings",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F13299290\">",
    " Metabolism/Transport Effects",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168018\">",
    " Drug Interactions",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168020\">",
    " Pregnancy Risk Factor",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F168033\">",
    " Pregnancy Implications",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047286\">",
    " Monitoring Parameters",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047278\">",
    " Mechanism of Action",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047292\">",
    " Pharmacokinetics (Adult data unless noted)",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F1047285\">",
    " Patient Information",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a href=\"#references\">",
    " REFERENCES",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " <div class=\"openRelatedGraphics\" id=\"DRUG_PED/13286\"
    rel=\"outline_link\">",
    " GRAPHICS",
    " <a class=\"graphics_icon\" href=\"#\" title=\"View All Related Graphics\">",
    " View All",
    " </a>",
    " </div>",
    " </h1>",
    " <div id=\"relatedGraphics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <div class=\"openRelatedGraphics\" id=\"DRUG_PED/13286|TAB\">",
    " <a href=\"#\" title=\"TABLES\">",
    " TABLES",
    " </a>",
    " </div>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?23/39/24183\"
    title=\"Lexicomp clinical abbreviations\">",
    " Lexicomp clinical abbreviations",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " RELATED TOPICS",
    " </h1>",
    " <div id=\"relatedTopics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"drug drug_general\" href=\"UTD.htm?12/7/12406?
    source=related_link\">",
    " Ethambutol: Drug information",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"drug drug_patient\" href=\"UTD.htm?7/56/8068?
    source=related_link\">",
    " Ethambutol: Patient drug information",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " </div>"].join("\n");
    var title_f6_13_6358="Fluvoxamine: Patient drug information";
    var content_f6_13_6358=[" <noscript>",
    " <div id=\"javascriptDisabled\">",
    " It seems to us that you have your JavaScript turned off on your browser.
    JavaScript is required in order for our site to behave correctly. Please enable
    your JavaScript to continue use our site.",
    " </div>",
    " </noscript>",
    " <div id=\"printHeader\">",
    " <div id=\"printHeaderLogo\">",
    " <img alt=\"UpToDate\" src=\"./../images/UTD2_masthead.myextg\">",
    " <img align=\"right\" alt=\"Wolters Kluwer Health\" height=\"40\"
    src=\"./../images/logoWKH.myextg\" width=\"175\">",
    " <br>",
    " <div id=\"printHeaderText\">",
    " Official reprint from UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " <br>",
    " <a href=\"file://www.uptodate.com\">",
    " www.uptodate.com",
    " </a>",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </br>",
    " </div>",
    " </br>",
    " </img>",
    " </img>",
    " </div>",
    " <div id=\"printHeaderLinks\">",
    " <a class=\"TOPIC\" href=\"#\" id=\"printHeaderPrint\" rel=\"3\" title=\"Click
    here to print\">",
    " Print",
    " </a>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a href=\"#\" id=\"printHeaderBack\" title=\"Back to normal view\">",
    " Back",
    " </a>",
    " </div>",
    " </div>",
    " <!-- TC:TOPIC_PAGE -->",
    " <div id=\"topicContent\">",
    " <div id=\"disclaimer\">",
    " The content on the UpToDate website is not intended nor recommended as a
    substitute",
    "for medical advice, diagnosis, or treatment. Always seek the advice of your own
    physician or",
    "other qualified health care professional regarding any medical questions or
    conditions. The",
    "use of this website is governed by the",
    " <a href=\"/home/terms-use\" target=\"_blank\">",
    " UpToDate Terms of Use",
    " </a>",
    " &copy;2013 UpToDate, Inc.",
    " </div>",
    " <div id=\"drugTitle\">",
    " Fluvoxamine: Patient drug information",
    " </div>",
    " <div id=\"lexiTitleImg\">",
    " <img height=\"17\" src=\"./../images/lexiComp/Lexicomp_2012_71x17.myextg\"
    width=\"71\"/>",
    " </div>",
    " <div class=\"clear\">",
    " </div>",
    " <div id=\"drugCopy\">",
    " Copyright 1978-2013 Lexicomp, Inc. All rights reserved.",
    " </div>",
    " <div id=\"topicText\">",
    " <p>",
    " (For additional information",
    " <a class=\"drug drug_general\" href=\"UTD.htm?28/50/29481?source=see_link\">",
    " see \"Fluvoxamine: Drug information\"",
    " </a>",
    " and",
    " <a class=\"drug drug_pediatric\" href=\"UTD.htm?40/22/41320?
    source=see_link\">",
    " see \"Fluvoxamine: Pediatric drug information\"",
    " </a>",
    " )",
    " </p>",
    " <div class=\"list ubnlist drugH1Div drugBrandNames\" id=\"F6195103\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Brand Names: U.S.",
    " </span>",
    " <ul>",
    " <li>",
    " Luvox&reg; CR",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"list cbnlist drugH1Div drugBrandNames\" id=\"F173600\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Brand Names: Canada",
    " </span>",
    " <ul>",
    " <li>",
    " Alti-Fluvoxamine;",
    " </li>",
    " <li>",
    " Apo-Fluvoxamine&reg;;",
    " </li>",
    " <li>",
    " Luvox&reg;;",
    " </li>",
    " <li>",
    " Novo-Fluvoxamine;",
    " </li>",
    " <li>",
    " Nu-Fluvoxamine;",
    " </li>",
    " <li>",
    " PMS-Fluvoxamine;",
    " </li>",
    " <li>",
    " Rhoxal-fluvoxamine;",
    " </li>",
    " <li>",
    " Riva-Fluvox;",
    " </li>",
    " <li>",
    " Sandoz-Fluvoxamine",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt war-os drugH1Div\" id=\"F10020320\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " Warning",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2700557",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Children and teens who take this drug may be at a greater risk of having
    thoughts or actions of suicide. Adults may also be at risk. The risk may be greater
    in people who have had these thoughts or actions in the past. Watch people who take
    this drug closely. Call the doctor right away if signs like low mood (depression),
    nervousness, restlessness, grouchiness, panic attacks, or changes in mood or
    actions are new or worse. Call the doctor right away if any thoughts or actions of
    suicide occur.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2700568",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " A very bad and sometimes deadly health problem called serotonin syndrome
    may happen. The risk may be greater if you take this drug with certain other drugs.
    Call your doctor right away if you have dizziness, very bad headache, agitation,
    hallucinations, fever, fast heartbeat, a heartbeat that does not feel normal,
    flushing, seizures, shakiness, sweating a lot, change in balance, change in
    thinking clearly and with logic, very bad upset stomach and throwing up, or very
    bad loose stools.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2700602",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Sometimes drugs are not safe when you take them with certain other drugs.
    Taking them together can cause bad side effects. This is one of those drugs. Be
    sure to talk to your doctor about all the drugs you take.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2700454",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " This drug comes with an extra patient fact sheet called a Medication Guide.
    Read it with care. Read it again each time this drug is refilled.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yya-os drugH1Div\" id=\"F10020322\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " What is this drug used for?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2691994",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " It is used to treat obsessive-compulsive problems.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2692084",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " It is used to treat social anxiety problems.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2691808",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " It is used to treat low mood (depression).",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2692021",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " It is used to treat post-traumatic stress.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt coi-os drugH1Div\" id=\"F10020321\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " What do I need to tell my doctor before I take this drug?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2702155",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have an allergy to fluvoxamine or any other part of this drug.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2705171",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you are allergic to any drugs, foods, or other substances. Tell your
    doctor about the allergy and what signs you had, like rash; hives; itching;
    shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or
    any other signs.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s4232023",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you are taking any of these drugs: Linezolid or methylene blue.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2703859",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have taken certain drugs used for low mood (depression) like
    isocarboxazid, phenelzine, or tranylcypromine or drugs used for Parkinson's disease
    like selegiline or rasagiline in the last 14 days. Taking this drug within 14 days
    of those drugs can cause very bad high blood pressure. Talk with your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2701047",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you are breast-feeding.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yye-os drugH1Div\" id=\"F10020326\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " What are some things I need to know or do while I take this drug?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697179",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have been taking this drug for many weeks, talk with your doctor
    before stopping. You may want to slowly stop this drug.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2700568",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " A very bad and sometimes deadly health problem called serotonin syndrome
    may happen. The risk may be greater if you take this drug with certain other drugs.
    Call your doctor right away if you have dizziness, very bad headache, agitation,
    hallucinations, fever, fast heartbeat, a heartbeat that does not feel normal,
    flushing, seizures, shakiness, sweating a lot, change in balance, change in
    thinking clearly and with logic, very bad upset stomach and throwing up, or very
    bad loose stools.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697184",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have bleeding problems, talk with your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697282",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have kidney disease, talk with your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697290",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have liver disease, talk with your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697339",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have seizures or are on seizure drugs, talk with your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2696717",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Check all drugs you are taking with your doctor. This drug may not mix well
    with some other drugs.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699677",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Keep a list of all your drugs (prescription, natural products, vitamins,
    OTC) with you. Give this list to your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2696611",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Avoid beer, wine, mixed drinks, or other drugs and natural products that
    slow your actions.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697622",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Talk with your doctor before using products that have aspirin, blood
    thinners, garlic, ginseng, ginkgo, ibuprofen or like products, pain drugs, or
    vitamin E.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697078",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you are taking any natural products, talk with your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s4128402",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you drink grapefruit juice or eat grapefruit often, talk with your
    doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697788",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " You may get sunburned more easily. Avoid sun, sunlamps, and tanning beds.
    Use sunscreen and wear clothing and eyewear that protects you from the sun.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697641",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Tell your doctor if you are pregnant or plan on getting pregnant. You will
    need to talk about the benefits and risks of using this drug while you are
    pregnant.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yyf-os drugH1Div\" id=\"F10020327\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " What are some side effects of this drug?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698060",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Feeling lightheaded, sleepy, having blurred eyesight, or a change in
    thinking clearly. Avoid driving and doing other tasks or actions that call for you
    to be alert or have clear eyesight until you see how this drug affects you.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698279",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Nervous and excitable.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698119",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Headache.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698272",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Upset stomach or throwing up. Many small meals, good mouth care, sucking
    hard, sugar-free candy, or chewing sugar-free gum may help.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698027",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Dry mouth. Good mouth care, sucking hard, sugar-free candy, or chewing
    sugar-free gum may help. See a dentist often.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2697963",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Change in sex ability.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698162",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Not able to sleep.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698255",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Muscle weakness.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yyh-os drugH1Div\" id=\"F10020329\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " What are some side effects that I need to call my doctor about right away?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698721",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you think there has been an overdose, call 1-800-222-1222 (the American
    Association of Poison Control Centers), your local poison control center
    (file://www.aapcc.org), or emergency room (ER) right away.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699066",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Signs of an allergic reaction, like rash; hives; itching; red, swollen,
    blistered, or peeling skin with or without fever; wheezing; tightness in the chest
    or throat; trouble breathing or talking; unusual hoarseness; or swelling of the
    mouth, face, lips, tongue, or throat.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698706",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you are planning to harm yourself or the want to harm yourself gets
    worse.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699058",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Change in thinking clearly and with logic.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699057",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Big change in balance.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698599",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Agitation, twitching, sweating, or muscle stiffness.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699112",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Very nervous and excitable.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698655",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " A fast heartbeat.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699042",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Very upset stomach or throwing up.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699105",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Any bruising or bleeding.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698603",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Any rash.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2698977",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Side effect or health problem is not better or you are feeling worse.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yyc-os drugH1Div\" id=\"F10020324\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " How is this drug best taken?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2696130",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " To gain the most benefit, do not miss doses.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2695914",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Take with or without food. Take with food if it causes an upset stomach.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2695322",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Long-acting products: Swallow whole. Do not chew, break, or crush.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2695861",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Take at bedtime.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yyd-os drugH1Div\" id=\"F10020325\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " What do I do if I miss a dose?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2696563",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Take a missed dose as soon as you think about it.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2696496",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If it is close to the time for your next dose, skip the missed dose and go
    back to your normal time.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2696475",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Do not take 2 doses at the same time or extra doses.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2696457",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Do not change the dose or stop this drug. Talk with the doctor.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yyi-os drugH1Div\" id=\"F10020330\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " How do I store and/or throw out this drug?",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699336",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Store at room temperature.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b498:s2699266",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Store in a dry place. Do not store in a bathroom.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"ord-stmt yyj-os drugH1Div\" id=\"F10020331\"
    xmlns=\"file://www.w3.org/1999/xhtml\">",
    " <span class=\"drugH1\">",
    " General drug facts",
    " </span>",
    " <ul class=\"statements\" style=\"list-style-type:none;\">",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s2699675",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If your symptoms or health problems do not get better or if they become
    worse, call your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s2699673",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Do not share your drugs with others and do not take anyone else's drugs.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s2699678",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Keep all drugs out of the reach of children and pets.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s2699709",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " If you have any questions about this drug, please talk with your doctor,
    pharmacist, or other health care provider.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s3302581",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " In Canada, take any unused drugs to the pharmacy. Also, visit
    file://www.hc-sc.gc.ca/hl-vs/iyh-vsv/med/disposal-defaire-eng.php#th to learn about
    the right way to get rid of unused drugs.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s2699677",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Keep a list of all your drugs (prescription, natural products, vitamins,
    OTC) with you. Give this list to your doctor.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s2699671",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " These are not all of the side effects that may occur. If you have questions
    about side effects, call your doctor. Call your doctor for medical advice about
    side effects.",
    " </span>",
    " </li>",
    " <li class=\"statement\">",
    " <span class=\"attributes\" style=\"display:none;\">",
    " <span class=\"entity\">",
    " &bull;",
    " </span>",
    " <span class=\"link\">",
    " urn:lims:b259:s2699683",
    " </span>",
    " </span>",
    " <span class=\"content\">",
    " Talk with the doctor before starting any new drug, including prescription
    or OTC, natural products, or vitamins.",
    " </span>",
    " </li>",
    " </ul>",
    " </div>",
    " </div>",
    " <div id=\"topicAgreement\">",
    " Use of UpToDate is subject to the",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_in_page\"
    target=\"_blank\">",
    " Subscription and License Agreement",
    " </a>",
    " .",
    " </div>",
    " <div id=\"topicVersionRevision\">",
    " Topic 12495 Version 40.0",
    " </div>",
    " </div>",
    " <div id=\"footer\">",
    " <div id=\"supportFooter\">",
    " <span class=\"sfInfo\">",
    " &copy; 2013 UpToDate, Inc. All rights reserved.",
    " </span>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_footer\">",
    " Subscription and License Agreement",
    " </a>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Release: 21.6- C21.56",
    " </span>",
    " <br/>",
    " <span class=\"sfInfo\">",
    " Licensed to:",
    " <span class=\"emphasis\">",
    " AsanBook Dig. Med. Lib.",
    " </span>",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Support Tag: [0503-200.167.4.114-3ADB073D65-S244013.14]",
    " <br/>",
    " </span>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6358=[""].join("\n");
    var outline_f6_13_6358=[" <div id=\"toggleOutline\">",
    " <a href=\"#\" title=\"Collapse Topic Outline\">",
    " <img alt=\"\" src=\"./../images/orange_arrow_left.myextg\"/>",
    " </a>",
    " </div>",
    " <div id=\"innerOutline\">",
    " <h1>",
    " TOPIC OUTLINE",
    " </h1>",
    " <div id=\"outline\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F6195103\">",
    " Brand Names: U.S.",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F173600\">",
    " Brand Names: Canada",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020320\">",
    " Warning",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020322\">",
    " What is this drug used for?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020321\">",
    " What do I need to tell my doctor before I take this drug?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020326\">",
    " What are some things I need to know or do while I take this drug?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020327\">",
    " What are some side effects of this drug?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020329\">",
    " What are some side effects that I need to call my doctor about right away?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020324\">",
    " How is this drug best taken?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020325\">",
    " What do I do if I miss a dose?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020330\">",
    " How do I store and/or throw out this drug?",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#F10020331\">",
    " General drug facts",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " RELATED TOPICS",
    " </h1>",
    " <div id=\"relatedTopics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"drug drug_general\" href=\"UTD.htm?28/50/29481?
    source=related_link\">",
    " Fluvoxamine: Drug information",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"drug drug_pediatric\" href=\"UTD.htm?40/22/41320?
    source=related_link\">",
    " Fluvoxamine: Pediatric drug information",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " </div>"].join("\n");
    var title_f6_13_6359="Overview of obstructive sleep apnea in adults";
    var content_f6_13_6359=[" <noscript>",
    " <div id=\"javascriptDisabled\">",
    " It seems to us that you have your JavaScript turned off on your browser.
    JavaScript is required in order for our site to behave correctly. Please enable
    your JavaScript to continue use our site.",
    " </div>",
    " </noscript>",
    " <div id=\"printHeader\">",
    " <div id=\"printHeaderLogo\">",
    " <img alt=\"UpToDate\" src=\"./../images/wk_utd-rgb.myextg\" width=\"220px\">",
    " </img>",
    " </div>",
    " <div id=\"printHeaderText\">",
    " Official reprint from UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " <a href=\"file://www.uptodate.com\">",
    " www.uptodate.com",
    " </a>",
    " <br>",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </br>",
    " </div>",
    " <div id=\"printHeaderLinks\">",
    " <a class=\"TOPIC\" href=\"#\" id=\"printHeaderPrint\" rel=\"3\" title=\"Click
    here to print\">",
    " Print",
    " </a>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a href=\"#\" id=\"printHeaderBack\" title=\"Back to normal view\">",
    " Back",
    " </a>",
    " </div>",
    " </div>",
    " <!-- TC:TOPIC_PAGE -->",
    " <div id=\"topicContent\">",
    " <div id=\"topicTitle\">",
    " Overview of obstructive sleep apnea in adults",
    " </div>",
    " <div id=\"topicContributors\">",
    " <div>",
    " <a id=\"authors\">",
    " </a>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6359/contributors\">",
    " Author",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6359/contributors\">",
    " Kingman P Strohl, MD",
    " </a>",
    " <br/>",
    " </div>",
    " <div>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6359/contributors\">",
    " Section Editor",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6359/contributors\">",
    " Robert C Basner, MD",
    " </a>",
    " <br/>",
    " </div>",
    " <div>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6359/contributors\">",
    " Deputy Editor",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6359/contributors\">",
    " April F Eichler, MD, MPH",
    " </a>",
    " <br/>",
    " </div>",
    " </div>",
    " <div id=\"disclosures\">",
    " <a href=\"UTD.htm?6/13/6359/contributor-disclosure\" target=\"_blank\">",
    " Disclosures",
    " </a>",
    " </div>",
    " <div id=\"reviewProcess\">",
    " <span>",
    " All topics are updated as new evidence becomes available and our",
    " </span>",
    " <a href=\"/home/editorial-policy\" target=\"_blank\">",
    " peer review process",
    " </a>",
    " <span>",
    " is complete.",
    " </span>",
    " </div>",
    " <div id=\"literatureReviewDate\">",
    " <span class=\"emphasis\">",
    " Literature review current through:",
    " </span>",
    " Oct 2013.",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <span class=\"emphasis\">",
    " This topic last updated:",
    " </span>",
    " Feb 12, 2013.",
    " </div>",
    " <div id=\"topicText\">",
    " <p class=\"headingAnchor\" id=\"H1\">",
    " <span class=\"h1\">",
    " INTRODUCTION",
    " </span>",
    " &nbsp;&mdash;&nbsp;Obstructive sleep apnea (OSA) is a common chronic disorder
    that often requires lifelong care [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/1\">",
    " 1",
    " </a>",
    " ]. Cardinal features in adults include:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Obstructive apneas, hypopneas, or respiratory effort related arousals.",
    " </li>",
    " <li>",
    " Daytime symptoms attributable to disrupted sleep, such as sleepiness,
    fatigue, or poor concentration.",
    " </li>",
    " <li>",
    " Signs of disturbed sleep, such as snoring, restlessness, or resuscitative
    snorts.",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " OSA is an important disorder because patients are at increased risk for poor
    neurocognitive performance and medical disorders, due to repeated arousals",
    " <span class=\"nowrap\">",
    " and/or",
    " </span>",
    " hypoxemia during sleep over months to years. The severity and duration of OSA
    necessary for development of these sequelae vary among individuals [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/2\">",
    " 2",
    " </a>",
    " ]. In addition, severe untreated OSA has been associated with increased all-
    cause and cardiovascular mortality.",
    " </p>",
    " <p>",
    " The epidemiology, risk factors, pathophysiology, and outcome of OSA in adults
    are reviewed here. The definition, clinical presentation, diagnosis, and treatment
    are discussed in detail elsewhere. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/40/41607?
    source=see_link\">",
    " \"Clinical presentation and diagnosis of obstructive sleep apnea in
    adults\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?2/48/2826?
    source=see_link\">",
    " \"Management of obstructive sleep apnea in adults\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2\">",
    " <span class=\"h1\">",
    " EPIDEMIOLOGY",
    " </span>",
    " &nbsp;&mdash;&nbsp;It is estimated that up to 26 percent of adults are at high
    risk for OSA [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/3,4\">",
    " 3,4",
    " </a>",
    " ]. The prevalence of OSA in general North American populations is
    approximately 20 percent if defined as an apnea hypopnea index (AHI) greater than
    five events per hour (the AHI is the number of apneas and hypopneas per hour of
    sleep) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/3\">",
    " 3",
    " </a>",
    " ]. In contrast, it is 2 to 9 percent if defined as an AHI greater than five
    events per hour accompanied by at least one symptom that is known to respond to
    treatment (eg, daytime sleepiness) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/3,5\">",
    " 3,5",
    " </a>",
    " ]. Therefore, it is common to be minimally symptomatic and have an AHI in an
    abnormal range.",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Age &ndash; The prevalence of OSA increases from 18 to 45 years of age, with
    a plateau occurring at 55 to 65 years of age [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/3,4\">",
    " 3,4",
    " </a>",
    " ].",
    " </li>",
    " <li>",
    " Ethnicity and race &ndash; OSA is more prevalent in African Americans who
    are younger than 35 years old, compared with Caucasians of the same age group. This
    observation is independent of body weight. The prevalence of OSA in Asia is similar
    to that in the United States, despite having a lower mean body weight. These
    observations suggest that race may be an important risk factor, possibly related to
    differences in craniofacial structure [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/1,5\">",
    " 1,5",
    " </a>",
    " ].",
    " </li>",
    " <li>",
    " Gender &ndash; Three to 4 percent of women and 6 to 9 percent of men have
    OSA, when defined as an AHI greater than five events per hour accompanied by
    daytime sleepiness or a cardiovascular morbidity (eg, hypertension). Some of the
    gender differences may be age-related, although there is little gender difference
    among adolescents or after the sixth decade.",
    " </li>",
    " </ul>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H4\">",
    " <span class=\"h1\">",
    " PATHOPHYSIOLOGY",
    " </span>",
    " &nbsp;&mdash;&nbsp;Brainstem nuclei coordinate the ventilatory actions of
    upper airway muscles, chest wall muscles, and the diaphragm [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " 5",
    " </a>",
    " ]. Phasic (ie, inspiratory, expiratory) neural output induces cyclic increases
    and decreases of ventilatory muscle activation; the result is a series of breaths
    that comprise the ventilatory rhythm. Whether this rhythm is regular, irregular, or
    periodic over time is determined by the ventilatory control system.",
    " </p>",
    " <p>",
    " Upper airway patency is maintained by the bony and cartilaginous structures
    surrounding the naso- and oropharynx, plus twelve pairs of skeletal muscles.
    Patients with OSA have a reduced upper airway size due to excess surrounding soft
    tissue or a highly compliant airway. A reduced airway size, combined with
    diminished neural output to the upper airway muscles during sleep and at apnea
    onset, can result in partial or complete upper airway collapse [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " 5",
    " </a>",
    " ]. The results are obstructive and mixed apneas. The tendency of the upper
    airway to collapse is determined by its critical closing pressure (Pcrit) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " 5",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?14/59/15286?
    source=see_link&amp;anchor=H4#H4\">",
    " \"Sleep related breathing disorders in adults: Definitions\", section on
    'Obstructive apnea'",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?14/59/15286?
    source=see_link&amp;anchor=H6#H6\">",
    " \"Sleep related breathing disorders in adults: Definitions\", section on
    'Mixed apnea'",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Apneas recur, at least in part, through a process referred to as \"loop gain\"
    [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " 5",
    " </a>",
    " ]. This can be conceptualized as follows. Apneas occur when the respiratory
    drive is less than the threshold for inspiratory muscle activation and for
    maintaining upper airway patency during sleep. As apnea progresses, respiratory
    drive increases until a threshold is passed. Inspiration then occurs. If an
    overshoot in ventilation drives down carbon dioxide levels, the respiratory drive
    may fall below the threshold for inspiration to occur. Thus, the next apnea results
    from overcompensation for the prior apnea.",
    " </p>",
    " <p>",
    " Individual variations in Pcrit and loop gain may explain why there exists a
    spectrum of OSA severity, as well as the appearance of central apneas during
    positive airway pressure titration (ie, complex sleep apnea) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " 5",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?23/56/24454?
    source=see_link\">",
    " \"Mechanisms and anatomic sites of upper airway obstruction in obstructive
    sleep apnea in adults\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H9969828\">",
    " <span class=\"h1\">",
    " RISK FACTORS",
    " </span>",
    " &nbsp;&mdash;&nbsp;Definite risk factors for OSA include obesity, craniofacial
    abnormalities, and upper airway soft tissue abnormalities. Potential risk factors
    include heredity, smoking, and nasal congestion:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Obesity is the best documented risk factor for OSA. The prevalence of OSA
    progressively increases as the body mass index and associated markers (eg, neck
    circumference, waist-to-hip ratio) increase [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/2\">",
    " 2",
    " </a>",
    " ].",
    " </li>",
    " <li>",
    " Craniofacial and upper airway soft tissue abnormalities each increase the
    likelihood of having or developing OSA [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/2\">",
    " 2",
    " </a>",
    " ]. Examples of such abnormalities include an abnormal maxillary or short
    mandibular size, a wide craniofacial base, tonsillar hypertrophy, and adenoid
    hypertrophy.",
    " </li>",
    " <li>",
    " Adult sleep apnea is a complex disease. It is not due to a single mutation
    or protein action. This conclusion is supported by evidence that only about one-
    fourth of the prevalence of OSA or an elevated apnea hypopnea index (AHI) has a
    genetic basis. In addition, the inheritance of obesity and craniofacial
    abnormalities explains only a fraction of the two- to four-fold increased
    likelihood of OSA or an elevated AHI among the family members of patients with OSA
    [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/6\">",
    " 6",
    " </a>",
    " ]. Familial clustering of OSA does not warrant testing asymptomatic family
    members.",
    " </li>",
    " <li>",
    " Current smokers (but not past smokers) are nearly three times more likely to
    have OSA than never smokers [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/2\">",
    " 2",
    " </a>",
    " ].",
    " </li>",
    " <li>",
    " Nasal congestion confers an approximately two-fold increase in the
    prevalence of OSA compared with controls, regardless of the cause of nasal
    congestion [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/2\">",
    " 2",
    " </a>",
    " ]. This is probably related to increased resistance due to decreased nasal
    patency [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " 5",
    " </a>",
    " ].",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " It is important to recognize that while these factors may be associated with
    OSA, their elimination is not necessarily curative of OSA. As examples, weight loss
    or correction of a craniofacial abnormality may resolve OSA, but smoking cessation
    and management of nasal congestion or septal deviation have a less predictable
    impact [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/1\">",
    " 1",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " OSA has also been associated with all cause mortality [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/7,8\">",
    " 7,8",
    " </a>",
    " ] and chronic medical illnesses, such as coronary heart disease and heart
    failure [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/9-11\">",
    " 9-11",
    " </a>",
    " ] stroke [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/12\">",
    " 12",
    " </a>",
    " ], hypoventilation syndrome [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/13\">",
    " 13",
    " </a>",
    " ], chronic obstructive pulmonary disease [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/14\">",
    " 14",
    " </a>",
    " ], idiopathic pulmonary fibrosis [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/15\">",
    " 15",
    " </a>",
    " ], and mental illness [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/16,17\">",
    " 16,17",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?8/43/8888?
    source=see_link\">",
    " \"Cheyne-Stokes breathing and obstructive sleep apnea in heart failure\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?37/39/38518?
    source=see_link\">",
    " \"Sleep related breathing disorders and stroke\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?21/40/22150?
    source=see_link\">",
    " \"Sleep-disordered breathing in COPD\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5\">",
    " <span class=\"h1\">",
    " CLINICAL MANIFESTATIONS",
    " </span>",
    " &nbsp;&mdash;&nbsp;Snoring and daytime sleepiness are the most common
    presenting complaints of OSA. Additional symptoms and signs include restless sleep,
    periods of silence terminated by loud snoring, fatigue, poor concentration,
    nocturnal angina, and awakening with a sensation of choking, gasping, or smothering
    (",
    " <a class=\"graphic graphic_table graphicRef55633 \" href=\"UTD.htm?
    12/10/12460\">",
    " table 1",
    " </a>",
    " ). The clinical manifestations of OSA are discussed elsewhere. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/40/41607?
    source=see_link\">",
    " \"Clinical presentation and diagnosis of obstructive sleep apnea in
    adults\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H6\">",
    " <span class=\"h1\">",
    " DIAGNOSIS",
    " </span>",
    " &nbsp;&mdash;&nbsp;In-laboratory polysomnography is the first-line diagnostic
    study when OSA is suspected. However, in-home portable monitoring is an acceptable
    alternative for some patients who are suspected of having OSA (",
    " <a class=\"graphic graphic_algorithm graphicRef80288 \" href=\"UTD.htm?
    22/5/22622\">",
    " algorithm 1",
    " </a>",
    " ). Diagnosis of OSA is discussed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/40/41607?
    source=see_link\">",
    " \"Clinical presentation and diagnosis of obstructive sleep apnea in
    adults\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H7\">",
    " <span class=\"h1\">",
    " DISEASE SPECTRUM",
    " </span>",
    " &nbsp;&mdash;&nbsp;Healthy individuals may experience periods of absent or
    decreased respiration at sleep onset or during rapid eye movement (REM) sleep.
    Events generally last less than 10 seconds",
    " <span class=\"nowrap\">",
    " and/or",
    " </span>",
    " are not repetitive. An isolated apnea lasting up to 30 seconds occurs normally
    during REM sleep [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " 5",
    " </a>",
    " ]. Episodes are infrequent, but may be accompanied by hypoxemia or followed by
    arousals or sleep-state changes. There are no known clinical sequelae.",
    " </p>",
    " <p>",
    " Snoring is common and its frequency increases with age [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/2\">",
    " 2",
    " </a>",
    " ]. Patients who snore are seven times more likely than non-snorers to develop
    OSA if they snore loudly on a regular basis. The pathophysiology, consequences,
    evaluation, and treatment of snoring are reviewed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?21/32/22022?
    source=see_link\">",
    " \"Overview of snoring in adults\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?1/61/2008?
    source=see_link\">",
    " \"Treatment of adults with snoring\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Some patients who are diagnosed with OSA have an AHI greater than 15 events
    per hour, but do not exhibit excessive sleepiness and do not have sleep-related
    comorbidities (",
    " <a class=\"graphic graphic_algorithm graphicRef80288 \" href=\"UTD.htm?
    22/5/22622\">",
    " algorithm 1",
    " </a>",
    " ). Such patients may have an increased risk of developing hypertension. In
    contrast, other patients who are diagnosed with OSA exhibit excessive sleepiness",
    " <span class=\"nowrap\">",
    " and/or",
    " </span>",
    " have sleep-related comorbidities (",
    " <a class=\"graphic graphic_algorithm graphicRef80288 \" href=\"UTD.htm?
    22/5/22622\">",
    " algorithm 1",
    " </a>",
    " ). Such patients are traditionally classified as having mild, moderate, or
    severe disease on the basis of symptoms or polysomnography AHI indices [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/16,18\">",
    " 16,18",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H8\">",
    " <span class=\"h2\">",
    " Mild",
    " </span>",
    " &nbsp;&mdash;&nbsp;Patients traditionally classified as having mild OSA are
    those with an AHI between 5 and 15 respiratory events per hour of sleep. Such
    patients may be relatively asymptomatic or report sedentary (ie, passive) daytime
    sleepiness, becoming noticeable once the patient is unstimulated. The daytime
    sleepiness often does not impair daily life, although it may be recognized by
    family members. Alternatively, daytime sleepiness may become apparent to the
    patient only after it improves due to weight loss, alcohol abstinence, or treatment
    of OSA. The sleep stages and slow wave sleep are generally preserved in mild OSA
    and systemic hypertension, cor pulmonale, and polycythemia are generally absent.
    Approximately 30 percent of patients with mild OSA will tolerate and respond to
    treatment, compared with placebo. Specifically, positive airway pressure therapy
    may reduce daytime sleepiness and blood pressure [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/19\">",
    " 19",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H9\">",
    " <span class=\"h2\">",
    " Moderate",
    " </span>",
    " &nbsp;&mdash;&nbsp;Patients traditionally classified as having moderate OSA
    are those with an AHI between 15 and 30 respiratory events per hour of sleep. Such
    patients are typically aware of daytime sleepiness and take steps to avoid falling
    asleep at inappropriate times (eg, taking a nap or avoiding driving long
    distances). They are able to continue their daily activities, but at reduced
    levels, and they may have an increased incidence of motor vehicle violations or
    accidents. Systemic hypertension may co-exist, but daytime signs or symptoms of cor
    pulmonale are usually absent. Sleep fragmentation is observed in moderate OSA, but
    the progression of sleep stages is better conserved than with severe disease.
    Patients with moderate OSA usually respond to positive airway pressure therapy with
    an improvement in daytime sleepiness, quality of life, and blood pressure [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/19\">",
    " 19",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H10\">",
    " <span class=\"h2\">",
    " Severe",
    " </span>",
    " &nbsp;&mdash;&nbsp;Patients classified as having severe OSA are those with an
    AHI greater than 30 respiratory events per hour of sleep",
    " <span class=\"nowrap\">",
    " and/or",
    " </span>",
    " an oxyhemoglobin saturation below 90 percent for more than 20 percent of the
    total sleep time. Such patients more often have daytime sleepiness that interferes
    with normal daily activities. They tend to fall asleep often during the day (and in
    a sitting posture) and are at risk for accidental injury from sleepiness. In
    addition, cardiopulmonary failure, nocturnal angina, polycythemia, or cor pulmonale
    may result from hypoxemia. Patients with severe OSA benefit from prompt therapeutic
    intervention [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/1,19\">",
    " 1,19",
    " </a>",
    " ]. Treatment will improve daytime sleepiness, hypertension, and, possibly,
    other hypoxemia-related abnormalities. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?17/47/18169?
    source=see_link&amp;anchor=H4#H4\">",
    " \"Cardiovascular effects of obstructive sleep apnea\", section on
    'Treatment'",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H11\">",
    " <span class=\"h1\">",
    " TREATMENT",
    " </span>",
    " &nbsp;&mdash;&nbsp;There are interventions of documented benefit in patients
    with OSA. These include behavioral modifications, weight loss, and OSA-specific
    therapies, such as positive airway pressure, oral appliances, and surgery . The
    treatment of OSA is discussed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?2/48/2826?
    source=see_link\">",
    " \"Management of obstructive sleep apnea in adults\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H12\">",
    " <span class=\"h1\">",
    " NATURAL HISTORY",
    " </span>",
    " &nbsp;&mdash;&nbsp;Patients with OSA are at increased risk of adverse clinical
    outcomes.",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Patients with untreated severe OSA (ie, an apnea hypopnea index greater than
    30 events per hour) appear to have a three- to six-fold increased risk of all-cause
    mortality compared to individuals without OSA [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/3,7,8\">",
    " 3,7,8",
    " </a>",
    " ]. In contrast, patients with untreated mild OSA may not be at increased
    risk for mortality compared with individuals without OSA [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/7,8\">",
    " 7,8",
    " </a>",
    " ].",
    " </li>",
    " <li>",
    " Untreated OSA may also be associated with the development of heart failure
    in men, particularly in those who have an AHI &ge;30 events per hour of sleep [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/10\">",
    " 10",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?17/47/18169?
    source=see_link\">",
    " \"Cardiovascular effects of obstructive sleep apnea\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?37/39/38518?
    source=see_link\">",
    " \"Sleep related breathing disorders and stroke\"",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " OSA is associated with excessive daytime sleepiness, inattention, and
    fatigue, which may impair daily function, induce or exacerbate cognitive deficits,
    and increase the likelihood of errors and accidents [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/3,16,18,20\">",
    " 3,16,18,20",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?4/24/4487?
    source=see_link\">",
    " \"Definition and consequences of sleep deprivation\"",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " Motor vehicle crashes are two to three times more common among patients with
    OSA than without OSA; this represents an impact on morbidity and mortality that is
    similar to the cardiovascular sequelae of OSA [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/20\">",
    " 20",
    " </a>",
    " ]. Treatment with CPAP reduces self-reported crashes by 50 to 75 percent [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/20\">",
    " 20",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?37/51/38710?
    source=see_link\">",
    " \"Performance and safety risks of sleep deprivation and sleep disorders\"",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " Patients with OSA have a propensity for night-time cardiac death, which
    differs from patients without OSA [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/9\">",
    " 9",
    " </a>",
    " ].",
    " </li>",
    " <li>",
    " Patients with OSA may be at greater risk for perioperative complications
    such as postoperative oxygen desaturation, acute respiratory failure, postoperative
    cardiac events, and intensive care unit transfers. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/29/35288?
    source=see_link\">",
    " \"Surgical risk and the preoperative evaluation and management of adults
    with obstructive sleep apnea\"",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " OSA is associated with diabetes or insulin resistance, although this may be
    due, in part, to risk factors common to both conditions [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/8\">",
    " 8",
    " </a>",
    " ].",
    " </li>",
    " <li>",
    " Patients with OSA use more medical resources, and have greater medical
    disability than individuals without OSA [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6359/abstract/21\">",
    " 21",
    " </a>",
    " ].",
    " </li>",
    " </ul>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"PATIENT_INFORMATION\">",
    " <span class=\"h1\">",
    " INFORMATION FOR PATIENTS",
    " </span>",
    " &nbsp;&mdash;&nbsp;UpToDate offers two types of patient education materials,
    &ldquo;The Basics&rdquo; and &ldquo;Beyond the Basics.&rdquo; The Basics patient
    education pieces are written in plain language, at the 5",
    " <sup>",
    " th",
    " </sup>",
    " to 6",
    " <sup>",
    " th",
    " </sup>",
    " grade reading level, and they answer the four or five key questions a patient
    might have about a given condition. These articles are best for patients who want a
    general overview and who prefer short, easy-to-read materials. Beyond the Basics
    patient education pieces are longer, more sophisticated, and more detailed. These
    articles are written at the 10",
    " <sup>",
    " th",
    " </sup>",
    " to 12",
    " <sup>",
    " th",
    " </sup>",
    " grade reading level and are best for patients who want in-depth information
    and are comfortable with some medical jargon.",
    " </p>",
    " <p>",
    " Here are the patient education articles that are relevant to this topic. We
    encourage you to print or e-mail these topics to your patients. (You can also
    locate patient education articles on a variety of subjects by searching on
    &ldquo;patient info&rdquo; and the keyword(s) of interest.)",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Basics topics (see",
    " <a class=\"medical medical_basics\" href=\"UTD.htm?38/4/38978?
    source=see_link\">",
    " \"Patient information: Daytime sleepiness (The Basics)\"",
    " </a>",
    " )",
    " </li>",
    " <li>",
    " Beyond the Basics topics (see",
    " <a class=\"medical medical_patient\" href=\"UTD.htm?25/25/26003?
    source=see_link\">",
    " \"Patient information: Sleep apnea in adults (Beyond the Basics)\"",
    " </a>",
    " )",
    " </li>",
    " </ul>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H14\">",
    " <span class=\"h1\">",
    " SUMMARY AND RECOMMENDATIONS",
    " </span>",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Cardinal features of obstructive sleep apnea (OSA) include irregular and
    abnormal respiratory patterns during sleep (eg, obstructive apneas, hypopneas,
    respiratory effort related arousals), loud snoring and snorts during sleep,
    symptoms attributable to disrupted sleep (eg, sleepiness, fatigue, poor
    concentration), and signs of disturbed sleep (eg, snoring, restlessness,
    resuscitative snorts). (See",
    " <a class=\"local\" href=\"#H1\">",
    " 'Introduction'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " The prevalence of OSA in the general adult population is approximately 20
    percent if it is defined as an apnea hypopnea index greater than five events per
    hour (the apnea hypopnea index [AHI] is the number of apneas and hypopneas per hour
    of sleep). In contrast, the prevalence is only 2 to 9 percent if defined as an AHI
    greater than five events per hour, accompanied by at least one symptom or sign of
    OSA. (See",
    " <a class=\"local\" href=\"#H2\">",
    " 'Epidemiology'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " Definite risk factors for OSA include obesity, craniofacial abnormalities,
    and upper airway soft tissue abnormalities. Potential risk factors include loud
    snoring, heredity, smoking, and nasal congestion. (See",
    " <a class=\"local\" href=\"#H9969828\">",
    " 'Risk factors'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " Snoring and daytime sleepiness are common manifestations of OSA. Additional
    symptoms and signs include restless sleep, periods of silence terminated by loud
    snorts or snoring, nocturnal angina, poor concentration, and awakening with a
    sensation of choking, gasping, or smothering (",
    " <a class=\"graphic graphic_table graphicRef55633 \" href=\"UTD.htm?
    12/10/12460\">",
    " table 1",
    " </a>",
    " ). The physical exam can be normal, although obesity, elevated blood
    pressure, a narrow airway, and a large neck circumference are common. Clinical
    manifestations of OSA are discussed elsewhere. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/40/41607?
    source=see_link\">",
    " \"Clinical presentation and diagnosis of obstructive sleep apnea in
    adults\"",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " In-laboratory polysomnography is the preferred diagnostic study when OSA is
    suspected (",
    " <a class=\"graphic graphic_algorithm graphicRef80288 \" href=\"UTD.htm?
    22/5/22622\">",
    " algorithm 1",
    " </a>",
    " ). The diagnosis of OSA is discussed elsewhere. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/40/41607?
    source=see_link\">",
    " \"Clinical presentation and diagnosis of obstructive sleep apnea in
    adults\"",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " There are several interventions that may benefit patients with OSA. These
    include behavior modifications and OSA-specific therapies (eg, positive airway
    pressure, oral appliances, and surgery). The treatment of OSA is discussed
    elsewhere. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?2/48/2826?
    source=see_link\">",
    " \"Management of obstructive sleep apnea in adults\"",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " Potential sequelae of OSA include mishaps due to excessive daytime
    sleepiness, inattention, or fatigue, as well as systemic hypertension, mild
    pulmonary hypertension, and cardiovascular morbidities. Patients with severe OSA
    (ie, AHI &gt;30 events per hour) appear to be at increased risk for all-cause
    mortality. (See",
    " <a class=\"local\" href=\"#H12\">",
    " 'Natural history'",
    " </a>",
    " above.)",
    " </li>",
    " </ul>",
    " </p>",
    " </div>",
    " <div id=\"topicAgreement\">",
    " Use of UpToDate is subject to the",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_in_page\"
    target=\"_blank\">",
    " Subscription and License Agreement",
    " </a>",
    " .",
    " </div>",
    " <div class=\"headingAnchor\" id=\"references\">",
    " <h1>",
    " REFERENCES",
    " </h1>",
    " <ol id=\"reference\">",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/1\">",
    " Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the
    evaluation, management and long-term care of obstructive sleep apnea in adults. J
    Clin Sleep Med 2009; 5:263.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/2\">",
    " Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in
    adults. JAMA 2004; 291:2013.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/3\">",
    " Young T, Palta M, Dempsey J, et al. Burden of sleep apnea: rationale,
    design, and major findings of the Wisconsin Sleep Cohort study. WMJ 2009;
    108:246.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/4\">",
    " Jennum P, Riha RL. Epidemiology of sleep apnoea/hypopnoea syndrome and
    sleep-disordered breathing. Eur Respir J 2009; 33:907.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/5\">",
    " Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep
    apnea. Physiol Rev 2010; 90:47.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/6\">",
    " Redline S, Tishler PV. The genetics of sleep apnea. Sleep Med Rev 2000;
    4:583.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/7\">",
    " Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk
    factor for all-cause mortality: the Busselton Health Study. Sleep 2008; 31:1079.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/8\">",
    " Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and
    mortality: a prospective cohort study. PLoS Med 2009; 6:e1000132.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/9\">",
    " Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease:
    an American Heart Association/american College Of Cardiology Foundation Scientific
    Statement from the American Heart Association Council for High Blood Pressure
    Research Professional Education Committee, Council on Clinical Cardiology, Stroke
    Council, and Council On Cardiovascular Nursing. In collaboration with the National
    Heart, Lung, and Blood Institute National Center on Sleep Disorders Research
    (National Institutes of Health). Circulation 2008; 118:1080.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/10\">",
    " Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive
    sleep apnea and incident coronary heart disease and heart failure: the sleep heart
    health study. Circulation 2010; 122:352.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/11\">",
    " Loke YK, Brown JW, Kwok CS, et al. Association of obstructive sleep apnea
    with risk of serious cardiovascular events: a systematic review and meta-analysis.
    Circ Cardiovasc Qual Outcomes 2012; 5:720.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/12\">",
    " Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk
    factor for stroke and death. N Engl J Med 2005; 353:2034.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/13\">",
    " Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients
    with obesity hypoventilation syndrome. Proc Am Thorac Soc 2008; 5:218.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/14\">",
    " Martinez CH, Han MK. Contribution of the environment and comorbidities to
    chronic obstructive pulmonary disease phenotypes. Med Clin North Am 2012; 96:713.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/15\">",
    " Lancaster LH, Mason WR, Parnell JA, et al. Obstructive sleep apnea is common
    in idiopathic pulmonary fibrosis. Chest 2009; 136:772.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/16\">",
    " Yaffe K, Laffan AM, Harrison SL, et al. Sleep-disordered breathing, hypoxia,
    and risk of mild cognitive impairment and dementia in older women. JAMA 2011;
    306:613.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/17\">",
    " Lin WC, Winkelman JW. Obstructive sleep apnea and severe mental illness:
    evolution and consequences. Curr Psychiatry Rep 2012; 14:503.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/18\">",
    " Strohl, K, Bonnie, R, Findley, L, et al. Sleep apnea, sleepiness and driving
    risk. American Journal of Respiratory and Critical Care Medicine 1999; 150:1463.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/19\">",
    " Giles TL, Lasserson TJ, Smith BH, et al. Continuous positive airways
    pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev
    2006; :CD001106.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/20\">",
    " George CF. Sleep apnea, alertness, and motor vehicle crashes. Am J Respir
    Crit Care Med 2007; 176:954.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6359/abstract/21\">",
    " Leger D, Bayon V, Laaban JP, Philip P. Impact of sleep apnea on economics.
    Sleep Med Rev 2012; 16:455.",
    " </a>",
    " </li>",
    " </ol>",
    " </div>",
    " <div id=\"topicVersionRevision\">",
    " Topic 7683 Version 14.0",
    " </div>",
    " </div>",
    " <div id=\"footer\">",
    " <div id=\"supportFooter\">",
    " <span class=\"sfInfo\">",
    " &copy; 2013 UpToDate, Inc. All rights reserved.",
    " </span>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_footer\">",
    " Subscription and License Agreement",
    " </a>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Release: 21.3 - C21.34",
    " </span>",
    " <br/>",
    " <span class=\"sfInfo\">",
    " Licensed to:",
    " <span class=\"emphasis\">",
    " Morehouse School of Medicine",
    " </span>",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Support Tag: [0505-194.187.108.93-69C8FD1B77-S473950.14]",
    " <br/>",
    " </span>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6359=[""].join("\n");
    var outline_f6_13_6359=[" <div id=\"toggleOutline\">",
    " <a href=\"#\" title=\"Collapse Topic Outline\">",
    " <img alt=\"\" src=\"./../images/orange_arrow_left.myextg\"/>",
    " </a>",
    " </div>",
    " <div id=\"innerOutline\">",
    " <h1>",
    " TOPIC OUTLINE",
    " </h1>",
    " <div id=\"outline\">",
    " <ul>",
    " <li>",
    " <a class=\"sr_button\" href=\"#H14\" id=\"summRecButton\">",
    " <span>",
    " SUMMARY &amp; RECOMMENDATIONS",
    " </span>",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H1\">",
    " INTRODUCTION",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H2\">",
    " EPIDEMIOLOGY",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H4\">",
    " PATHOPHYSIOLOGY",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H9969828\">",
    " RISK FACTORS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H5\">",
    " CLINICAL MANIFESTATIONS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H6\">",
    " DIAGNOSIS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H7\">",
    " DISEASE SPECTRUM",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H8\">",
    " Mild",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H9\">",
    " Moderate",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H10\">",
    " Severe",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H11\">",
    " TREATMENT",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H12\">",
    " NATURAL HISTORY",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#PATIENT_INFORMATION\">",
    " INFORMATION FOR PATIENTS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H14\">",
    " SUMMARY AND RECOMMENDATIONS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a href=\"#references\">",
    " REFERENCES",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " <div class=\"openRelatedGraphics\" id=\"PULM/7683\" rel=\"outline_link\">",
    " GRAPHICS",
    " <a class=\"graphics_icon\" href=\"#\" title=\"View All Related Graphics\">",
    " View All",
    " </a>",
    " </div>",
    " </h1>",
    " <div id=\"relatedGraphics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <div class=\"openRelatedGraphics\" id=\"PULM/7683|ALG\">",
    " <a href=\"#\" title=\"ALGORITHMS\">",
    " ALGORITHMS",
    " </a>",
    " </div>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_algorithm\" href=\"UTD.htm?22/5/22622\"
    title=\"algorithm 1\">",
    " OSA diagnosis algorithm",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <div class=\"openRelatedGraphics\" id=\"PULM/7683|TAB\">",
    " <a href=\"#\" title=\"TABLES\">",
    " TABLES",
    " </a>",
    " </div>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?12/10/12460\" title=\"table
    1\">",
    " Clinical features OSA",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " RELATED TOPICS",
    " </h1>",
    " <div id=\"relatedTopics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?17/47/18169?
    source=related_link\">",
    " Cardiovascular effects of obstructive sleep apnea",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?8/43/8888?
    source=related_link\">",
    " Cheyne-Stokes breathing and obstructive sleep apnea in heart failure",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/40/41607?
    source=related_link\">",
    " Clinical presentation and diagnosis of obstructive sleep apnea in adults",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?4/24/4487?
    source=related_link\">",
    " Definition and consequences of sleep deprivation",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?2/48/2826?
    source=related_link\">",
    " Management of obstructive sleep apnea in adults",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?23/56/24454?
    source=related_link\">",
    " Mechanisms and anatomic sites of upper airway obstruction in obstructive
    sleep apnea in adults",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?21/32/22022?
    source=related_link\">",
    " Overview of snoring in adults",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_basics\" href=\"UTD.htm?38/4/38978?
    source=related_link\">",
    " Patient information: Daytime sleepiness (The Basics)",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_patient\" href=\"UTD.htm?25/25/26003?
    source=related_link\">",
    " Patient information: Sleep apnea in adults (Beyond the Basics)",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?37/51/38710?
    source=related_link\">",
    " Performance and safety risks of sleep deprivation and sleep disorders",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?37/39/38518?
    source=related_link\">",
    " Sleep related breathing disorders and stroke",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?14/59/15286?
    source=related_link\">",
    " Sleep related breathing disorders in adults: Definitions",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?21/40/22150?
    source=related_link\">",
    " Sleep-disordered breathing in COPD",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/29/35288?
    source=related_link\">",
    " Surgical risk and the preoperative evaluation and management of adults with
    obstructive sleep apnea",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?1/61/2008?
    source=related_link\">",
    " Treatment of adults with snoring",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " </div>"].join("\n");
    var title_f6_13_6360="Folliculitis decalvans";
    var content_f6_13_6360=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=DERM
    %2F87488&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=2\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=DERM
    %2F87488&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=2\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\" style=\"width: 596px\">",
    " <div class=\"ttl\">",
    " Folliculitis decalvans",
    " </div>",
    " <div class=\"cntnt\" style=\"width: 576px; height: 432px; background-image:
    url(data:image/jpeg;base64,/9j/4AAQSkZJRgABAQAAAQABAAD/2wBDAAYEBQYFBAYGBQYHBwYIChAK
    CgkJChQODwwQFxQYGBcUFhYaHSUfGhsjHBYWICwgIyYnKSopGR8tMC0oMCUoKSj/2wBDAQcHBwoIChMKChM
    oGhYaKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCgoKCj/wAARCAGwAk
    ADASIAAhEBAxEB/8QAHwAAAQUBAQEBAQEAAAAAAAAAAAECAwQFBgcICQoL/8QAtRAAAgEDAwIEAwUFBAQAA
    AF9AQIDAAQRBRIhMUEGE1FhByJxFDKBkaEII0KxwRVS0fAkM2JyggkKFhcYGRolJicoKSo0NTY3ODk6Q0RF
    RkdISUpTVFVWV1hZWmNkZWZnaGlqc3R1dnd4eXqDhIWGh4iJipKTlJWWl5iZmqKjpKWmp6ipqrKztLW2t7i
    5usLDxMXGx8jJytLT1NXW19jZ2uHi4+Tl5ufo6erx8vP09fb3+Pn6/8QAHwEAAwEBAQEBAQEBAQAAAAAAAA
    ECAwQFBgcICQoL/8QAtREAAgECBAQDBAcFBAQAAQJ3AAECAxEEBSExBhJBUQdhcRMiMoEIFEKRobHBCSMzU
    vAVYnLRChYkNOEl8RcYGRomJygpKjU2Nzg5OkNERUZHSElKU1RVVldYWVpjZGVmZ2hpanN0dXZ3eHl6goOE
    hYaHiImKkpOUlZaXmJmaoqOkpaanqKmqsrO0tba3uLm6wsPExcbHyMnK0tPU1dbX2Nna4uPk5ebn6Onq8vP
    09fb3+Pn6/9oADAMBAAIRAxEAPwD5UooopgFFFFABSikpaAFopBS0AFFGKWgAoxQKcvWmAqrxzSY9K09H0W
    51ZZpIGgSKAAu8sgQDP160s1lZWx2yX4lcHBWFcgD61Sj3FdGbGgY5Iz/Wrkfng4hVxGSDsHIP4U62iSWeN
    bbMvzZCsMZ+tdHFp5a3e4VCgY4wWOV+lUopCbOcubVQ5JLo552sm2t608PwLbwXEjN5ci43Y4J+tXLyxmkt
    0cyKY4sGNj1+hohac6dIYpC0AOWKHKg+wqmuqBPa5s2T21rp8VsfLYI25Hz84B7VsRRLDbnaxF1Lxg8lh2q
    noEelyiN79Y3LjGRkFaW1W3n1W4RZCbdRmBnc8Y7cVlJya3NqSXNZdSRNPWCLfnzdpJbJ+43XIrBvLrzXuP
    MVZJLg8OvUCugukfyp2WXYzjaEzuBzxnPYViSWiWOlbZeJB86zDlWwelOE+4VKavZGIyosZFrGSHO3a/8AC
    R2z71auZYn0cTxoqSs2yWM9V96HijdtzyhUlYbSBkA46YrOSFppJVfLHlSG4OR3q3LTQwtsVUKLe+S77ohj
    DL2zWhqKRiOS2t1I8ohge5rIti8UUoMYI3j5iOcZrTnYvqF6Iz/rUCBvQetLVlWsQgRXFgyqQlw42gNwDg9
    jWVZSPb3QZo84yro3oeoqeRZIsKpDJu+V/wC6RT/OUmN5YiWL7yezVW7ElyjW8+4kWPG4oQi/7vb9KlRhbz
    ieJS8EU4BQ9XHUgmreiKHv7m4OECK7bfQ/5NOsYk2SeembVycHuCRjNUrEPTQb/aMSatctb2qmyk3B4m5Ow
    +nuKuxy/YbG5tpYGEd3GphfPzDByGz+NZ00Vofs0spkjjLbJJI+dh75Hr7VpR272zXDGQXFksYw6HIY54I/
    qKEr7k37Fe3kli2SSZe1TDYXp9a1JlMrXMU1w20gSR7WJXB/hzVGcww7fNiZWVizMn3SD0b86ryXEtxK6Su
    qwryNvGamSSLi3LRiT3kjzxzSIjRqBEVboQKfbyI8bXLSTRb2wGHzBR6EVA7mW28pQDCH5x1q5pVs0jTKkW
    dnzEnpt+lJMrlLqxI1rlrhJWI24+8apwwSMxRJRE5PCltoIrpbTSoop47q3VXi43rnbkY6itTUtKtWtGkFq
    gVow6SH+tTJ9y4QZwxt5ZnigEXlsD85A5rbsVt7NGMceSG2s0gzn6VswaSbyyVrfHycsHbDKfY+lXNP+zx2
    DWl4ULbxtRVyGPue1YyZ0RhY5u98u4lbYgbcMKcY/GtXw+otx9mljVtoDK7rnFa8uhpaxyvFIryggiMcgZ6
    DNWJNPizZSxhorndiXPQZrPndzeFDvuPsA95PJLIixxphVVeFOD1rqlghngEqrKYw/I24BpmlaPHEq+aWMz
    nI4yPqau6hfOQbKJQrIMAHgAeuaxqTuddKjyuyKsgWIxvuKlDgn27VOpMt6I4jl3Xqe3qayo4b24nMDzQqA
    N4ycE4q9o1nJvdiXDFSd56H6VhLVHW4crNm1t1ijEUagfxfWrJtlJCjjjPHrUljFhFPXgDNXBCD1H4CsiJG
    Q1vtzz8/v2oay3JkjJPetgxqWOEye/FKoG08HPpiqRm9Tn/sTKR39qinsyGBKAitxsl+V6d6ikYjllyp9qB
    GC9mMZ2nNQ/Yi2Sp/CujUqflSPt3qJrYPyMccnFA+hzb2zKQpprQgAgr+NdFJabh79qrGycY3Ej8KCTnmhP
    I5Ix0qJoQeqHNdA9qclkIPakNuSNpU4+lO5TRzTRryo4P0qCS2DccZrqZdOjfBAKtVJ7D52yp47incjkOZk
    hOMHnHT2qrKdhxIh2/Sulks/l+5xVaaxaThTwOxFPmIcWtjETymQ7R+FMnt0df3iBlPtWk+ltuYheR3FQGO
    QAgg8diKtSZm430ZzGo+GLC8QsqeW/tXF6t4Yu7JiUXzE65AzXq5Q4B27T39KjYnaFZQO3StoVrHPOinseH
    SQsrlSCGHY8UCH/ayfSvUvEOg293C7xKBKBnI4rhdQ0WezHmbS3HYV1RmpHLKDiYJ4bFK3NTmMMp+X5+tRA
    Eg4BqiCOg0Ypf4aaYFOiil4xUAJRRRQAuKWiinYAooFLSAKXFAFL3oABS4pQMc1NBFLcSrHEpZj0HrTBERZ
    mA7gdu1amk6aL1niZWVzymD19RXT6J4che2iWQlbktjr39MUt9ZT20SxyL5M4f5H24/UVpy6XJTV7M2LDw3
    ZiygninC8YZD95PrTLaBvJummVnt4eVK4DL+HpVey1+OKGRLuApdRgKzIOvvTb+8M82QvlCdcB84H41m7s2
    vbYq6pcbIBLLbqtq/
    +qBIyfUmppILSXO11hhIwibifqM/WqHiKZoRbGVYpoQdqjqAc1s2WoQnSrjzNNtZpM7U2gjHq1a0/dWphU1
    fujYIIEe3NnBIcHD/ALzhj6+wqw63MD7YNhulYhty8Z+vfisy6gkhiS40w7YX+chgcr7Vds5bS9jEV9cNb3
    C8h2B+Y+9JyV9C1Gys9GT2tzIltJJJawSXXR8SFTjPp0qne21w+ls9jIr2x3AiRsbM9iPWmpKVmtINWjKw7
    2/0mHrKOwplzcyafZ3Is5lljSTfkDLsh/ve9Q3FlapXuY1ks8tvMRsjuYf3mSwwR6fWlWZ7u6eRsRSEAnHU
    /hUEVx5l8y+TAyyHIzwCOwqnIWjunkQhWjfcFJzj2FXa6siO1zU1JLeGDzbMM67hu3HnI6/rUVokcjebN50
    UTg/Oi7h+NQxytPas4XG19zDHUmpLKcrbtbSuywuQxYLnaM001ezDbVFjU9HuI7GH7K0V1agl2ltznOfUdQ
    aphAlhskV2ti3DgYKN6H61r6deTW8jzWm2RWk4ABHH0qCe6/tC7eNfLhjl4IxxIc9/emkrEtt7mfpiuLHU1
    zy0I2j1+YZFQWswtZYmlUtHkB165B4OPetw6c1jfgSMqOVPyOePasy506fyo8ptMhyWA6HPalawJ73HCSaG
    ea1hPnRSPyG6Oe2D2NXmsmtlSLaIoJT80bygkNWV9nV5o0Z1DLIQQ56kHrW1o1iNSv7t58RNIpaEgZGewA7
    mqT7ESiPntJvswezlSdYhteMHLRD39R71kmKPzkWT5WK8g9Aa6ObT49NkeadpnZlxKVGCPbFZ95p8auJTMN
    qnBx82FPem9UOOjIdPsFe5iWNkdt45zwCe1dbIiWt3LazmMM6YJiX7tc5BpjIEkKNG2dybP4vRhWnY3Mlve
    O9/meMgDeg5H1rnbOmMUzolW4GjfZo2Vowu5XIw3HcVHEx1e2mkiEccSlY3Qthi3sPSp1lhvYvKtZFEIU7i
    WwQKdbiKza3lMI+yswBXHCt61DaW51RSeiHwW00DrI6MoH3Ny/erQmh8q1kukgR2OQ3+1/8AXrpYphMuyNk
    chTlW9PaqUtjFJp0wmcsuD8rcVm2mdKgYejWouUSRixMnKMTgMPTHtVq8imtmt5zGVdDg85DgVNbaZNC9gd
    wSPd5Wwg9+4xWzNoF8qqLiYC2UnY5ySM98VLSY1eOjOgsUlnRZpmWKKRQR5f07ntTZbeKbb5SR7g3fvRpa3
    MdlGsroqkY4HynHHPpUsKCGcAqsbk8c8H8awlozeMl1KtzpaBTmNHTd0xyai2fZoEeJjlX6Z42/3fat6JFk
    DZVAw/i7rWbd2Bljnkhk2hDuYdnrNotSuy7p4McClTnPY9qsx7y+Gxkc4rO06SVlUAKwPzcnGc1rJs6SZiY
    dz0NZ2Y5MCGVvlBJ7k1FKzIuGU/hUjyGJ8lgyfWmSzkqcLgUIiwibQpZgfbillwCoUZXqRjpSpIpCcE1Pjo
    VwBnimS0VZbVJFU7sZ5x6VGICB83ReausvXcvsTTCdgyM4HT3oFcpmLBYZznkY9KaylR8n61ZJaaTjgHnGO
    ntTZF7ZHHpQFymFRn+ddo9RSMqqxBRgDxmp1QjOQaafnXawLY9aB3KEikbgQSR05qM58s5wPY1bKEy52E49
    O1IUDg7kOc9aAuZ+xlOGQYPp3qs8aj76gbea1JbfzE4bB9arFGUlZAGbsaBWuZsyBtrL9091qndRRxrvcYX
    17VtJGg4ZQuTggdKbdWg+ZWQOn9096YNGAtvHLHnGV9qr3WmLt3ISfTNdCtkkS7oxhQOFHpTNgbkD5TT5mh
    NJnIT2Lhc8VmXcS8iSMEEYxiu6mtA6nbjI7VlXmn5IBTPvVqo0YypX1R5ZqugpJOWh2o56ACuZvNHubYszL
    kDg4r16/wBLZA3kqSx71z727BzFcjBz3rqhV0OKpRs7nlk0TIx3DFRlSE9q9B1i1scESxjd2A61ztzoUoia
    VE2IOgPWt1JHPys5OiiigQUUUtACiirlg0AbFxbtMp67WwRVme1sZCDa3LRsesc46fiK0SbWgrmUKcKs3Fl
    NBy65XqGXkVWqGmtxjgcdqVVzQBxzW7o3h+4v0WcgLAT1FIDO0+zkvJ1iTueuK9T8N+EILO3SWcAz9uKPDu
    gW8LowUDyuSfWusNypA2ISM4ArCrVsduHoKXvM5/VNMEB8+1fZdngwMPlf6Gs83rWtrt1SImNG3An7yH0Pt
    710typnYiZHbZzhByT7VzOuLLqMvltGytCCAFGd49/pTo1JMK9KKvbc5yaJL25uFjuNjyHPTh/bPt2qKT7S
    1t5ShGUDksclRWxf6LFHp0d5pUxMabfNVvvK309Ky5Z0a4VYkEYxh2JOfwHeutnBs7lfTooLnSruC8ZUbeG
    jlJ4BHT862tMVk0+O1jljY5LkgZZT6e4qrqo0z7LEbSzmbcQsksj7QT/uiqzD7JdfuAS0Yyqx5Uknrg07CT
    d7s6qFILe9hjt54rhnXfIhBAHtiqrWdtcXFx5p8icZaNmOSy+1ZV3EzW0c0f2hJZTt3E8r+XWovscTT7Wa4
    lcRjY8j8j6YpbKyNH725ZubC5Yyjn7GeFMjfd/2sdqzhBdNKs0kTzxNlDIpPzDpzW7pOjypeT/aLqV0aIbJ
    PvdexzVHW55tK8+wW5FxbsAQVBGG7cUlbqJpmJpmlwvqbxXbmGNG4kxjHt/9euhns7aK/hs5LIyXJUmCRU4
    l9mHr7ijRg+rWv2SQxR6gceT5y4WXnkbuxpt0zxaulpdu1vIJMRTM5xC3dc9gauNkZO73MqDTtQW+lRLTY4
    DB42/lVuzshfTIEkhTyUCtHL8pJ9Aa25oDZ3Ml9b3LXiRABl3/ADkHvnvg96yb1UnuTIsmYbkbyxGG3j9DT
    dlqOz2Zl6lFLpKyW6YxIdwfptPsa09N06S908XBkWOWLAG4csSetXdetIRbwR2k7SsYBJJuAKg+ntXX+GtC
    T+wo5rpo9m0SKD1XjoPaobSNY076HGX9tcSxy3UqEbQAXB+U+9ZZ81/JuTkpuI46ZxXpurWVlqdnHb2uUSR
    kV1RcY9eO1c7d6NKk7pb2zvHAm0FB0werDuaWr1QOCRwckBnvhjqwHzdjXU+Fklgu4I55R5ZIMUo58o+9QX
    1isDQ7pQXzvIQYC56023tpZZTbxsVRQxXJIP1+lSpcu5TgpbGwTM+qPBcsXjuTt3DocVSvLSaFBOkbgW6+R
    PGw/I/SpIVSS5gAnl3gEHPGzA7evNbnhy5jN3fx37rNLPHjzG7DGBTc7hGl0MqzjSb7LJZpJK6/vAJB+BU4
    6CtGNba8TYtuUZn+aPPzZ9R64pPC+nT2fiYQrPCpZHj8sMTuPX9a73wv4Vtr0H7VOqxSZ8s7cOjDqM/w1lO
    rfQ68NhotOUn8jlbXTItPn/4mcDfZ5sYYcDk9Qf6V0N3pWGJeEvbJwuPXtn8K07iObSjJpmtGKSyfH2aVhl
    M+/cfWsi81S/0qKfTL0IYzzFJnqp9+
    +KylM6KcOn3GnCsKW3kNG0Uqt5e4jPuKmFldXEKxyFTCMcBcE496k8NKJ3eW9ZXm4O4D5CBwMV0ssKmLbbM
    Qf4VIyKz50dfLZHNyW919qt5AF2xOGBxwa09Yurg2wV/nbuB2q4Y7jg3EQiRecL0Y0+SBZFzuBcjkYxSumN
    JdStps4XTo4yplYjr+tXZF3mNJVUR4LZY5wfSnwQRGBTDFsA4OO5pJreVyYwpCgZ3Y71N0RJJltNORUEhfz
    VKg9cY+nrWbeIVe5Mcm5dv3G4PSrsa/ukJYtgY61UlQSSzu0YJbABY0bhGLvZD9Gtkkt1cPjAwBWpJEJYDG
    xwBWbZK1mPlGVPUYzj3rRRnJByoFZyKlHXUzxYrbtt81pSeSp6CpUUuxUDaBVwwSEknacc8VVm3I64zl26C
    syXdipbsp4P0pJVkKjyeMetWlCyDYp2lRyadtwue1MT0K8MjFQOp7k0siMqq+QfmprMACSD+FNIV4/wCIDH
    UUgtcVlUszRnDUu/OCVz2qKGXbiJ0PsT3qQt5ikJ07e1AuURgjL94g1VljG7hsn61OsLMBgZOe1OMAJ3Acj
    qtMexT2FQQO/cVFh1YqQQe3vWiVVVAYDaTkUssSOoGPxPekBlMoOAB8uelRyxKp5HPSrhgVSdoIA6e1OlC7
    SDhsDk0Bcy5IXY8jkUDcRsPHoT2q/tUKQuSO2etU3QgZ56/lTAryRtA/95D19qheBYnyu4xt1x2q9Ed7bWX
    6f/XpTEocqTkgdPWgkoXEKKm5Gxnv6iq5iLqHBDY6rV9IvLkeJ14I+XNRTKbaRX259QO4oAx5IQMhuPSsXW
    dGFwNw5fscV2M0AbDoFIIyAf4hVKeMsoZAAB6dqpSaJlBS0Z5Dqlg8cjCdcODwcdqsBVKwbxn+93rutY0kX
    0DAhQa4aezNrcFiGyp2lM9RXTGSmjhnB05HjVFFFdRxhTqbTqAHKxXgE4+tAPekxVlEjSASsyszcBB1Huaa
    VwGxzSRD5WIz2JyPypCwc5K4PtTeScmt7whpCavq0UVwWW2H+sYHoKbfQdrieG9Jmvb2MPFmHrlumK9RtLe
    C32LBGEi6bR0BqOLTLW2BtdNDNGp4c9a2NOsSg2XIGw/x+tc1Wrpyo7MPQ6shiiCSkliFI6DvWvbiOFN7IA
    54UHtVW7KxR+REAShyXPTFShzKm9nDDICn0rlmrnfDTSxUuJ5o0lCk+fk4bsPasOzjnSUXMcqiYHdz25rbv
    kCO8UMzSSEbiccA028M0cKAQwMgAUsTiuqlDlje5zVZc0/QqaklgEkkkdIhj5RF/fPWvO57aPzZXicsrdTj
    BrrtQkkkMz+Sttbk/KkZBUn1rnL8JNMRFKiPgZGOHrphJM4K6d79CFcw/JEquxXeHbkinadM72mya2luoy5
    OSfu56EUt1atAkkyxN5RG1lDZ/wAisexkee4VIZJFznhWI4FVzWZm43RuT3UP2N4Y2KSB/LKkHgeuaqWM0t
    tzA4MgG7J5z7ZpieZFnz2G52wIz1bPQ10Qmhht2dIAZcBJl2YMTDv+Iok+o4PoUdP1CaD7cznLEKef6VUml
    guJnucosz8AOCTj1qlPHJcXsz2R37m4B6ke1byaVLc6ctxcqUD8FgMAY7Vnd7ItIzdPuh9nkt5yXJJVGHBz
    65rTljn1CEbl+0m3iMRdxzn3qjYWEL3dwkrkBcENngehrc0y5trXS7uGXA1Dc3zFvvZ6fpVXa1BRT0F0wwT
    aKwlhlWaIEM6fLjHcf4VlXS29nFGssDPDMCweH72OxPvWr4bR2CpbzKouVPmCTJQn0+vpTtVimsZR5cBgkR
    eY3X7+e6/WqvcJQa3RRglD2Mq2u24LJsIfh4/Xmu9isbqTQLdtIuTMkUYjlSTBKj0FeYQh7i+cxuYtw4B7n
    0r0rwwb3SoW87mGNQZAoyVX1I7j3rCpPodmFpttt7CiO9TUPMwkMqRAru4WQemehNbPhKaF9LvIbgvBevIW
    KgfM2R0B6YrTttQsDp26aGM20sZxJGdwJ61zfh+eM218ZiQsEhaF88xn196IytsOcddtDlPGtkft0TwptAB
    K+oK84NR6UVu9TWe5bKyrz2H0rX19LjUbgzXTKi+S8sboM7j3yOxqHSLOMwWgWPyi5DK3XJ6dKdnuzNJXsj
    JntG/th7hmZIeiEdFHr9KtSSrBpYh2RvcJMGVwOXXup9q3NVkQXZto3QiRGWVyuM47D8a57UNOupreDyVDM
    nLAdSaE7BKO5YuYyL+BvPBdf3wMZ+ZSvQCvSvC2pCUvAjb2njDoijoe4+teQwWk1kwlnjdQ33ufmjFdVoM7
    2awXttMRPBlWBbG5TWdSJ04aSPVrjSk1CzZb0GSTGMN0FcfFB5N/DpmowmdYHLb3GSYz0wa6Oz1SWa0d7YN
    JuwRz3xXOao1z/a0Ut4SrOMFejLWSaWh1um37yZ2Wn2VzZxyrbxrJZbt/kEchf9k1dhZXXfaSMq4zsYdPwq
    TwveSvb7ZkDMqjp1AFM1i3/wBNjntZDFI/8O07WPoR71E1ZaE81nZipLKzhZGj29cbMCp5YfMjUxNHu/vc8
    fhTLBvtkZ8iIjDYbeMbTVrb5e6I7XJOcjjFRC43ZvQy2vmsmK3MYY9dyHjPrin22rreSsEY7R1zUc9szzPv
    yVcYIAyKjs7QxnYsarsfGQOWHqaqUdToUYcuu5rQqkRwSCG5BP8AKllTAGVBHep5LYrCCVBz1zTYrdFUbHw
    D2PIqHpoc7dtUVMFUba2AaVZNsIUnIAxkVPM8aSeWF57g0yTyhjaMdyakd7kTTskfy7yPQ09GQorPlfT1qb
    /WbcdPUUyS1ZgcEY96Vhcy2I7eNssUxg8VKQsY+YncOCM0RKUQxnqOpFEsYAHlAkkck07Et6kUzh2Ozj04o
    wpjOOAPT1qVYi2FUc054QnLqVo5RcxnXEHnQkbyhPRh1FLYEQKIZnLPjhz/ABVZ8rzCQAevFULqNzIFQfMh
    yTngVNjRSTRpRvwzIeAeaabgAttIweQCOT7UyLcQEP3Scg1KLfEpLEY7UXIehEcMgOSFPUY6GmsSCpByM1a
    aFsnaCc+hqIxkcbjn0oJuVXIDNzxUc5yMg44xgDrU0xx8qqCPaolV0BEikL2NBSKsOSVB5NNl3crnDD171M
    MAkKSW6470jMkibWyGAyDjJPtQDKpPyk4w39aYd7ASLjKnBzUp2s4yO/Wo2CxyL1JPGKZI7KSptc4Y
    cq1NjTzsxN94fdNShE27euecntUEiMk+M7T2NMLECptbZICoYkqf7p9KidSI2B6jkj+taUwWZDnAJ6n39ar
    bSUDMP3ijax9aBGYYgDhuVI4Nc9r2jtKGmhHzD26100qMvyDBx0/wqMYlRlZTkcEelOLaYpRvufIVLRinY4
    r07HijaWjGKUdaAClA5FHU09V5600A+FGeRVUEk8ACvTPC+lfY7JQC3mNy5xXMeF9KkeUTuhI7V6LDKbdER
    EIZuOawqztojrw9O+rNrS7UBOBxWpGilCr/AHBVfTIpJbZWSUBs4PGcU67S58sqjqw6ZxXE73uelBp7FWb5
    baSMqH83IT2+tPS2lh05Z5lxsGxFPc+tWTE0MMMRCndw2eo96ivdRa4tJIoySYhsViOg9a1ik9GZtuL0Me5
    MzHyYn/eMwLkD7op2tzMkX2ddoZsdq1pVit9KMmwecwAHHNVb20j+zC4uXG+Tpz0960vqJQ0uzBlSJF8hfm
    XaC7Ht61xl48EmtEWse4MwVj2UZrs7qyN1MIbZX8plx5rfKJK45oGt3uoW2qWb5e9aQlZXOerG+hLZSm3jm
    EjZKyFcnnvWLqDiCcyJbqF3ZZ04PNWo4ZI5J05c4z/9eq9zOys+EyGGDnvWkZ2dznnFWt2IXMqOPm3wE70J
    bOM9q2Lm7mjdfMHmfJsZt2Cw9D71hwFo0kQgvEMHPoa6dtNUmFrxsw3CZVwMc44rXdGFtUkNsJo1uI5Psq2
    yR8hgSxP1NdtoGlC+tybriJ8EI0mAOfvVyGl3NrZSxmVVlZG8ponPDA9811SSxXUKrZs1pcAY25+U+tZc9n
    qdVOnzLQq3djZReI9Qs4UQxhF5GSOnb1qh4m0yGNYXt41JdBncMbWrptBn2TIlxCsbuMJI2Du9fm7VPqVgk
    UJEx+UMQCTye4FEpJo19i46swNA057SFb11BjKqU8s8qfXFaJsbjWXlkuZN906HBJzwPSrqSSppcjwQFxt2
    MmP9XjuKrNHcwTrdOjLbMBGgUYOevFJNx2Hyqa1MLSNJM0QSUCOcSlT32D3r17R9KO+SG4KZiQKJ1GV9j+I
    7V5dcsRqsbwSzCIACRhwCM55NeneFrky3C3dv5aWl2mwqGO3K/wAX40pNMdO8W4ox9b8JT2sf2zT2c2wfFx
    ahvlPPJX0ptvDYWxLyxKMghtrZUnsa6q91D7HdPDNyj4OV5Cn1z6Vz9lJC91dQSQv5IbMLEfLzzj86lTtob
    +yb94w7LSGvridiCrOcRgHAIp02jzWVwRJIS0IbYuwlRnoP/r13VvaOJxdIhjn27duPl471Uuftd3qPkSfu
    lKFWlByCvcfXPPtROdiVRu+Y5K0tRPqcEElmZDFGfNIGRkjr9auadEbYOkMaOzXIJaTg49MVr2lqQYJCBGs
    wIDM33gPf1yP1rQs7S1UmOWTziGLkBdxyaSlYn2fM7nMa74fj8q4Fw4YzHIRD0J7D6Vn+F9JfUbS6s7jKRQ
    kpGduGbHuK67WNO3o/2eRwgHCjkj8KwtJuLix1qOFgYYmUO3y5CsuT+op8xpGnZrUu2elvpkbhZZrf+7HID
    tf3DdqplvOvHnu7jZOjABJTn5favTdNMV9YJIWV7dxlT1FR6tolje26RGKFdpyGVcMT9ahtM0jOUXZbGToW
    rJHK4twJUbILqp4rZvNVK2bSAo2whgcYOc9KybG1msbswuVXOCrDhXHoR2NV7iL7W87AbJC+SFOVFQ1Y6I0
    1Uldm1b3zfbkdIhsmHz4POfpWhud8sVwG9uaxdKIidEkILY+Ujoa3lkOARgD0qG7E1I8r0RFCT5m3YD7mrq
    m3Zj8nlnpkDrVVpzvJC8gYzSxAk7iSDUKTM3ruPu5lePaqtuz1PQ1lr5glyD1HQVbkd2JBDEdiKrOZd4Cj8
    DSld6scbJDpIZZINzMpPYnrmkR0MIygLjg809PMbiRT7AUTwND8zqBn9KPNE83RkkFxGI8mP5x0xUyh5CGY
    rz0FV4h5YPAwRwTT4VUndJJ8w6AUXIdidowGw+AwPGKa5diVVQGPX3+lMwWO52znuanUxiMZJxjjHamSVEz
    GGGOaeZj5RYjLDoDTgcZ2Ddnqe9QKyiT5xnPOKL2KVmQTmSUK+H2Z528U1nYgKiKEHPvVpiG3LEMD0NLdWz
    w2+5RmZQCFA6/jS5eYtWRWSPdktkjPGOoqVgAxDPkdRnrSQyzW6yLND97BLKefyqUlJgOx9DwRUuNhskjx5
    bEE/h3qDOC2Rz6mpVjjBABJx1wadcoBEzgEYzzRZmehWlRHQFMhh1PrUDklM5LYODVlF+0RROwIXqaRkKEN
    CcKxxg0BsZc6gSAqNwz1pjIcllHzYIzWm8RO3K/MOeOmKryjafk+6x6dxQMzcMSQw+9yPShHHmbWXPb6VZm
    TC57E4+tV7lQoLfxDpQMRW3hkLfMD8vFQ3DERMZF+ZD+NTByzdAGWoZ3LNGxOM8GmIkYKYhcR8qMbl9Karo
    JCGb5G4PHT3pLORUKgsCGG1qa6nDMoyIzimDG3FuVlKjkkZx/WqFxuVPMQbWHyn3962E3TuwPLqvGPSqMkb
    bc5B5ww9qAPjcHBoJyeabSivUueGLSgUnenZxSAVa1dD0/7Zc/OCIl5z71n20ZlkVB1Nd94egSGNY5l2O2D
    04xUzdlc0px5pWOo0GyENuixqMY9K1lgUsVf5nP6Cix+WLEXOOMitCwt1EmeveuCc9T16VNJE8KrGA9orR4
    GGQ9D71pWYdgrMvvzVbf5bY4INW3lkaOJSMj26io5rs2UGlYp6qhuLnepA2jBap5tIQaezL0OD7tzUlrGkt
    2oYfu0OSB3NaF7I92Y4YWCQDl3Xr9K2TuZuLuZepRI1tgJmQgYUdqy7/R5ri0f7QT5mBsQHjPpXUNaeQEmR
    MIDhgeePWmXMitvWKEybPvHOAfpVNoEr6M5K7sN8MUEjbJwPmjB5H0rmta0SCyYiQFn6jHOc9jXokkdq0kU
    0wfG7O7OMccAfjXN6zMLuRo5NrRq2WYYB+mKpPoZON7s4y9WG1lMEQCEptBPqe3FYmu2aFLZI5B5zH5uwAr
    rLQwSXsf7vCxyMynPL8cZpZNMF+LiSaNgNpKEHgYFbpa2OKcXZs4eCERxQO65JJJUfxY9a2tauWudPs/LXb
    HCAwI9O9JcWFzGI12eau4hSvpjpWjZLaxWVusxHmK4DFumw9qtuxjBbEFn4fWeS3mmlEdu+CzYz8p6n8K7b
    T9M0+Xy7WC6jeSF/lPQsB3NchaSPZ7rTa8zRSEAN93YemR6V6Z4T0nS5NMju7i42XkvI2gZXt+Vc8pJe6d9
    Gm7p9yZLK0FvNGdp2Ydc9M9DiqniSIxWS26L+9lZfv8AIOOhQ/0rp5tOg2OsL7sRgsxHPWsLxFYzX8sUaDy
    4wN5ye3Y/UmhM6pxU3oU9ORxaXT25E4dsRjtz1JqRRIwtorheYTkk9OnWsrw802nXVzbK7G0VgSze9dpJG0
    ZinPzBvlIx1B6U1IcaHu36mXJpNu7sxVUSRSr45XPv6VV8GvLa6lNpb25MdsWZCO6t0xXRaMiXN7dxTII0D
    jCt349Kwij2PiidLZ3VCu7PUAj+EfUUr3M5Q5JJnVJJZuJhcxMSqiNuM5rmFlkt73AjP9mxkou/gRk9DXWa
    XaTm0Uy4M8zFjkZx7/lUkum28xltTEbhG+WQdd/
    +FSVzqOhHYxzytGlvcIUlXY28ZAx0IPvUmoeYluqBYNsPITnMgHX/AD3qnYacba4NoSoMJBUgkgqemPU9jW
    vcxwyaTIXSONtoVvUe9DelkDd9jk9DtLnVZ7uHVZkzG+bfbwEBOVx+PFdros0d3Zjz4UWdfkZkGAxHGa4OY
    st5Z3Vs0jwzyEPtUnGe2fwH4111pqENsfOCtGcLy5CiQ+o9+xpNmbVtOpLquns4xEdikY6fermtbsbuyexu
    7WMBVkCSFumPc13MhvLy0jlVbe3RhuAc7mwe/pVDyVQHz0+0Z4JzuA9wtLmV9Soza0RnabO0dizRgQuGPyY
    +V1z0A/rWvY3dnNCWJCn+6TyfpUdm8M8cZ3H5PlJA6Y9aiIGySONQ2yX5WI4APNN2LT6sZqs0MkUiIQpKjB
    J6HPaqVjEySSE4IY4fH8VW59MBJmRVZVOduMZ+nvVu2SJI1CNGCOWz0U+/v7VJ0KooxGmwj8xJ8iIqMBfar
    bSKVG1ZOOM7acJljXMUUkpP8bL/ACpY5pQwJhTBGcs/86mSMXUbGJIAw/u96srdqE2gZH0qrd+bMMpHHu7A
    NzmnxsflN1CUPQMDlc1CTMm7mgJgUVdo+bpjtVeSICTdjkVKkRIJjyKi/e/bcMTtVcH3NXa5F+xKsXy52mq
    0jlHYSKWJ7mtGByqYzk1XmDM/Td6jFJx7Ep66lFlYj5QCG4FCoqSDzF+b0xmrJtykgHcj8BS3SAoCoGR3qN
    i1qyOUQzZPRT2FMY7DtX7nTHekjjL5YjBbr6UkwTco3HcKaZdraEoYKBt6ng80ya0IYyD5fY0hiYsCh2Dqa
    kklJ+YkED8aLi1voQxurPtmGx+3HBFWYZnjYhW3KfUVXykrMsiBsjkf3fenRROixyKxeMHBJ6ihOw5bBLFJ
    OrtucBmGM8g0zBjcSKQ2ByGGQaTzHLlWlCoc4K1GWHkKruN5wAfxpPUoerxvKW8uNlxjjjmn3UAdEhQsu7k
    kH+HvSLAq3Eqs3ygBhxjNPtXJWSRyMltoB7CpJfkQrHNCq+U4ZASNr8H2piMJUkUKY5e6N29/pVmBy+8gFC
    rc+9R3CJO6rKSQAcMPvA/4UANeMhAsbdOT71UuY2dYSq/NmrUbskqxOQH2cY6H/wCvT4Jd0PMbYQ8HFMV7a
    mZJFv4Bx3x6mq80fmqwGTnrxWpLGIgxUDBYHioWZA/yjkHt6UDuZTqWBBUq2BUTRBoiGXG08GtKZVkyUOSB
    nBqoVEkTjlc8fSlYLmTcI8UgKcHtipbW7bcHcfL/ABj1qxNGTIoB4J79qhe32SuR91u3pTQNkyTiK48yEde
    QfbuKsX0avGk0YAJ+96EVlR7ojz1zkfSrtvKzM8K/df5gD60xdT4upaSlA5r0zxB2KVRk0nerumWb3l0kSD
    qeTSuC1Nrwlp3mzedKvyjp7131raBmIYfTjpVLRLAW+ECgBeldJBsV/kX5uhrlqS1PQo09B1tbSwsqq2Ae/
    UGt9IHgQf3j2FRW+1FBxzjpWhENsQJGS3r2rlk7s9GEeXQZDbbtu9hn1qaR2RJRGOcYzTbZWduRgZrRFujS
    4GMD9amO5pJ2RW023dguVK8HJ7nmteG3JQYG1VOaj8x0uI0TBXBq/bknMjDCjr7itNOhjeSWpHeSeTZyEqO
    VNZFvGLZQhOdoDJ3zmn65fq+1UUsu4DaO5qtcowjRriQ+dH/rEXgbfQVol3KcWtSlduDG1puWWdWLhW4Azz
    WRf6fNJaEFgA4JOwY/Cuv02KzjuWkIXc6jOagUQQteIzKvlnKIT1B7/h/WtU9NTNrldkcfYaDJH5N1DGFQD
    aysPvA+/atlbQWtvO9xE7Iw2EKM+UPT3rplAGmKqIViVNw3dWOOv0qjb2z38S3shYQq3zxD/lp/tVfNfYxj
    DdHmVpGovTEGdSJS0bNx8prSh063+1XcRgd4IkZOmdzYzmum1+xsEZmiMaOP3qNjnOOn41Vg1KC7t55rcLl
    ogcDuQOtNyJpUfedzNtbG3g1PT5p7aQ2rgKzMpyR6Gu+bTI1miksoYnU/6tVYjCjr+FYFpKJ7W1tfM/eyIW
    +hxxXSeFwk8H2mVldo02yInG1h1xUud9TdU3T0ZcZ5bwzSQ2ixAKE2h8gfSsq/t5Y1ZGjcyyMrbi4+VM85r
    T+32yTypCpZgcx/7f8As1JdfPYzSGNnlddzHA4I7UtNzSN9jl7xYpGntY4kLyMQpDDAxWjYo0OlWz38siXG
    RtCjcCM8c1MukvJbxzeQB5nzcsB157Vf/seSS5ggecvKF3PtO3y0x2+tSvM6akoKKSZSWyluYpbmN2jSQ4L
    g5Kkdcn19hWXqX2RZdPtreJTIkpZ5S33iF6E9zV/UtunWohslKpuIEa5xIxGQPY1mnwu+pGCZZHhk+ZkaMk
    Zx6g+tN36HKmp/Eb1prDRFFt0YpIBH6lGxyM+ldJHKos0htk8t5Mjduzn1bNc54VskNnLHcpxEW2SdP3vv6
    YrYgAMT3cQ+dhtkiB446ke9DTMbR5rIz/EztBYrNb5SS2+YAdSueR/Wsca9DLZB2dJNp2yLn15H86k1/wC1
    3iyLpzhyynAPp3H1rAfwv9lhnvp50d7j5fJA+ZSFznHpWau2d0KcYpX6m7dzn7FshYqihZMDgcEGnSWhiv5
    bqJvNglQnYxygJ5Jz2otjO0CAxKIzDnduyORirlu893YRRokfMex1JwM4xmnqhVYRlOyNHw1O7WEUQYeYpK
    nDbh9CP6itZrjcpVFWJs7WkI4B9v8A69cjp1tdRaTPbo8kd5E+0Mi5x6H39xXQ6XJJLHFDcoIcDazyHIkbv
    x2pWOZxK0uk3NveySW9zIzP8xUqCD9cVcsLjF24miI8wjaQuQTjkVaOnSxSFobpowTxBsyrj8OQahSJYpmj
    vrT7O8mTGm/MYYejepp2D2l1YsZnv5PLs4/LjBx5j8YPqPWn2mlwWk0sZJJyH81vvEnqfzqKzVsbXs2LgnO
    04z702Od5bqUI88BPyrv5HHX+dK9zJpsvXCssq5YMD0Yf1pZg0EY8xeD6DNUbiW5hDRuFbcQPNHb6j+tXvt
    pCiMZkuW4WP+77n2oaC0ktCs93EhwpXj7xbov/ANeopt94hEEdwU7u42Ln2FbENpHEis22WUrktjofYUy6j
    lMIK4SNRkknFOKsLnuZkCXkQMb3rQoB91F3En6npVW1hvwkk4umli3EbplGSfwq9K0i253Hy1AOMj5n9/YV
    HFpd15ETRNsizhgxzuz6CmaRS3ZVg1kK+2WIo4O1gDuXPsa6CxuFkgZwRg0y10u1tllTy907n72AcjH6UWu
    mvBDjdtBznNFmTUcHohWG5uQRnvVdoiJDkllPTFWYxJkrLINg7jrTbh4beLczY7ADqfpUMlStoQFDvVVPy9
    xVWZSn3kw54zUrSzTgIkbx4HRFy35mo5EjyBMZie5diOalo0TBWaXKlT8lPbCAMVwfVeajmgLAGKSRVHIIb
    NMEk8cZ3Kko7lRtNKwx+1SwYOVds8kcGkhaQOUGCvTHaq73EewBnaJgc4cVJDMzCTypAxxwR2oje47XQy4t
    5hc+YoAVhjK8gmny22VzsJYjOaRrlYvLcybSp+YU6K4lusRxSfNgqp9FznJpy1HqkRuHkcBmO1QMnt+FAK5
    Y5JKngetTzMQgj5UJzj0PeqflFWYsx2gjPrg1DQRfc0IQU+Z1K7wep60m2NtrglSy8io/KBYbHJHVTn07U7
    adkb7T5WGAHvRYkhv4yZSE+8i7lx3NEcvmxl7d9pdQ2D93/wDXUcsomdWIMZClSc96gs8NA7D+I5GOgB7UB
    y6F6QeWiNkdCDnpVQRhi7KvzZxipZCG8lfM7cq1NLMoLKAcccUEpFOIbRgjhjyKp3GVllKg7AMg+1aLKCSF
    PK/Niqk6EqyxkA7SOfegaRXeT/VZA/vZHekkIaR1469aeyEwRhtu5RjPuKhkDhlLDlx1+lA7FOfiMHPIP6U
    0yGNw3IxhhVgKGYHaCG/KqdywV1IGShwRntTCx8e04daTBBxTh1r0zwxR1IHU9K9B8GaOY08+T5cjPvXI6D
    Zm8vlBHyrya9T06PZGi4wAKxqStob0ad3cngTy3IxktyDVmAOJUUH5m5P0o2E/OOG/pVuxjDFnHDHgVyTZ6
    dNWNiBdqqzHgVcWXzflBHHSspXkZCnWpLRJFcs65GMDBrBnSjXUsF6DGcZq1BlsckqOtZMLyAkbfmJ4B6Vp
    xyBVMWcSEc47UJalN9yuL9JdTjjUlhE30rp5mZ4QFGM9q5/QdJKXEku4rk5Pc10c1qAmI5pNx681rAmXLzW
    MdreKK4hkcghCWP19KR4JbiXfgCd0JUHsPerU9llY4SxOP3jt3wKnSMK5ebLHcEXHcVsnYJvmuZN8VsLaOa
    8tyshHl/IMjd2rLaB4Lo7VBd4ssXGS3qMetb1y0l1rD27tm18skFuzdM0ksyWksKH5CAArsMsce3vTfmZJ3
    FitZI7KCR7iRbUqCIpcZf8AwHtWNZ61IqSRW24hQQUddvQkfyrajMmVhjRwjk7HkO5/pz0rn9X0tUuN8WXn
    WQ4yxwx9M0mVBa3ZzV7eTNrCrNA8kbDGwOOCelTPB/ZDwPBHJC0rHzdwyqAj+tdLpdlHFdQXqxIu0nCY3EM
    Oop2rl9VvoyYlhi3BX4y7Y5BPYU4JLcutBuSa6FHTre3aIJcXAjucZYYO5R/DXVeH4o7QuYDHJJN/rCHG1O
    ODUENjHezzFlZpOFeVzk9Ohq/sthLDBcRRR27AIqFMOPTJHXPrVaImrUb1NHTtHgSaO5uWy6HKBBjr1z61D
    L5cupzxRSMsC85J4PtT1S5t7hbdGka0cExkj5hjqAT3qUGyt1iMRwwyfmGSAe59OaVzFT1uynFd3Msggtl3
    vuKqMYC47n2FKLZLe1nku7+d3ZSSsJ259yetWtLtp557vytyRF8+Y33pARzVXXrIeSlkkDeY38RfO9Byc0B
    KpfQ5nxUYrHT7ae3XYsZV2EjlycchsVq6XdXECx3Ks9zHOizeQwwcn+4fXPauZ1qykvLQ28LyLMDtIPXp05
    rR8MQOptUuJGP2djuRycAdj+Jp+YpRtI6/SpGL3seziUlipH3SRzn8aueHNNWC1WO9lb5yWRu5Oeh9qxLj9
    1eRTJG1urNteVHI3HsCPStnRbomyYXEpby5MeW64fB7570N9CXexZvbJbYtcQhVhzg4HKn1FY99YN5+53R5
    du92H8hW090t3vt12uIQeT1bNYdws0Cug54KKG9CKXMdFLmUdyfSbMJbTx/eSNiisOmzGR/OrmiWsbW8ltJ
    GDJGQwA7qeQarWbGOZVGBDNCo4PcCtyHZbG0uxwNohk/3G6E/Q/zqb3MqsmVpbBbNXKlmV38wHPKEDkH1FJ
    DafviVcNDdAHJ5wR/nrW9Kkcs64IJCk8dq5q5k/sm5khbJhmO+JR/A+en40EU5XR0SwXFugKEOh/vn5z7Bq
    pX13G8DsACU5KOOntiprdtRuIo5PIjjDdVYkkA1T1e1KRNM8gaVVJ44H0qhJa2Zg3mpyWi5tJv3cg27H7ZH
    8JrR0cXckaNPbbI3GFDsMgUXFjZzWKXEgXgAwqp/MY7mrcFq00eJlMFuRyCeWH9KlK250Pl5dEMmVy7xWc3
    7scFtuVH+NQ2qrYSBZjuIIVHB4JPJyfWr7TKsa/ZQJVT5ShOCg/rVQXMckhkhgaQNyWblB+Hc0iObQ05Ltb
    dWYhmAOBtHX6VGtxNNIrzkBR9yIHIX3PqapxS27ES/aFdH4C5yyj0A9ParEzRJET5oCgZOBkke3pQzLRjpM
    TOdx3op3MR3PYU4wRyhWmmkjKNuUq+0H2Pr9KggeWbaIYVghU/K03r67f8AGpItMMc+
    +aSSYnnc7Z/LFJSHZPQkad9zNtfAzy7BfyFTLO7xhfMyuOxqWJFfCAKMfxbef1pL+2hRVEIxO3G5OAB64qi
    b62Kk0hUbYyMA/O/UL/8AXqeytk8zz5AdxGAzHJA9/ek8nZH5Uq8oM4HINQw3TK7Qsp3r0GO3vSsOzlsXpF
    xJgHJ659KqyXCEyKxyAOe9Txh5I1AxkrxzVVbcxSvlBvJzxzQ0OMe42MKiEx7cOc4FIykH5xtA7k4pJImEn
    yDPPSortZPMyx+VanUqyIZnEm+FV3OmGUqucg+9QSOgjjMKJls7mUdQKsW6zQXCyxAMjHy2B7g/yqpeXi2i
    3CxoHiBwjbS20n+EY6mtI23KitbEN7ujVRHHy3ryxHcgdhSadKsXmoZcEc5oZTCkclyftM6rkMxOEB9MUv2
    dQGY/K5OSmO1TUh1
    LjtZl9t0zHylB4z7sO9LthULJnPOwj0JHFVbVio+VgHUZGaSCUC4fd88bjDKf4T6isRW6EiO8eCw5B9e/pV
    p5UEnOTG3zbAeh9azLS8+23ctuY9gj4Z/U9qfdjbHgr8wBCsM0By3LcpJ+ZQowMqfU1UsmKuqqB1PB4+opY
    JHIjVuEHHI6VL5JVn6K4bIHegVraMUMcnEY9dp6iklVXVc70RuuO1NSdRLvbjecfSpbtNsb7cnjK4PeixJU
    YAtvLfMvQDuKgfd55ZTkd+KnD71V2XHGDmoHIWfKMfUA+tFhldlMYAIJXOQT2pssXCsOe/41NOGADDODyRj
    vVVbsN50EmdwXdmiwavYSUCN0dAQrHmquowAHzFQtt4OKuKxWFgcMKibazEEkJIMg0wPjEnJye9KOv1poq7
    pMBuL2NccA5Nem31PDtc7HwvZLFbRyEYY8muwtxkgg5HasvT0AREAGB1PtWzYJtLrjpyPpXBVldnp0IWRet
    kAXLDNX41VYRt71BBAXRjkhQM5qdGCuO47VjLY7ILUt2sIwMDk1rJAIoPnKr7msq3nZjshA9S/YfSpL+YyS
    pZwE+YwzI7c7F/xpKxo3Ykt3jklT7MXkCsd7Y4P0rYQL97ycEjJGOcVFb2pgtY9ihUUcCpPMzHkdTwKTdth
    QjzO5YspJELCOFyjdxjitSJ9i48mQjoTjJqPS7faimRcMeQfWtKbbHFuGd3bFEFoJv3jIlmxeOSHUFRHypp
    Y5EnEUUcg83cd+7jaP8asyBvLm3El8jYO+abpETfaZDNtkQtuOR95q3j3J16CT2TRXmDtVzDvTPoKpW8CT3
    wnmB3Y79h9a1PEDC3MNzCx2RsQ69flPWs9QZLPcjNuUFUYckiqd2Ok+XcmkjE88tvDg7hvUk8LjuTWBcZuL
    54LJ/JJXJPUBh6Z71rlY0shlXkl6tgYBPvVeG3xciXBj8wZ652sKp6mlOHcjtbC50/dcIyTeanmyDoxI6kD
    pkVBbzJHMJPMUybd7Iy85boKmub1oolhikV3E2xUPGQ1aKRPp/lx7ITE77nz03/4UN3JleJmQ2eo2+qRxSt
    KsF0pkLIQWYD7wHYHpXYQWlm9oIoYUKNwXzlj/AMC65rmNXjlkhN5Cdj2JDDy3KgAn5uO5xVq2juZP3lvPg
    TKGAkGML3PHFJo5+ZvcXU9RuMLaRNu8lsNO3RMdCD3aq2iXN3d3UsMkKuUfdgngk/xH3q1HsRj51u6RA5Q+
    pPBb6mtFIYYv9JCMiA7HXy+qn1PrQNSitWasN6qSSqSXI2khOcEis2OaS7u552hIVR5ce5gNvrWfd6za2t1
    NYWrrJdMQo2j5UGPvMe1bkAtINNi8+eNnIzjeMflQZrc5jVLiEa8JLiNUzDgLnIJHfjvVRr9bJzfWytNEsX
    kzxt94Kedw9watavPBcXQtvNgVXQtng7VHesfQrjT57qVr+3uIo48jzI+d57BgfX1pudrROyFGNveOh+32u
    p2PlxvG7yKSQeB8vUVPA4+wSyK4VVkHlvuyV6Y/CuSu9TtrKKeCOBkukk3ozndBJEeMcc7x/Sug0O4ktrJE
    UwyWfmYNxCu9XbOfmHUD9KDJtXsjZiltSjXUksaXUWcgZGT/AHSPQ1FqN2L60M1imSqkqGYDt82afqkiyWo
    ubWUNOeGUYwT2zXJWaXyz3JvVWG4U/u0BwXBPqPSk9NDWnSck5M3bG5lm00eUUQxxjDZyQR0/wrodOvft1q
    VdflK7eRgdK4yKV7DXo7Wf57e7PmIy+o+8v+FbR1WGLUpoYXLQsAyqf4exFIfsXPRI6zSpNxAfJ+UAepx1p
    dXhVjEZYg0W7awPPBFZ+m3H+lPHg/MolQjt2P61qXE3m2ZDgCQMAwH1po5JQcJFKNriykSJpZZbIMMAnLJ7
    Z7io9ckeaDFtH5gcfQCtm7SMWZU8HcCxH1zSXKxIrTwgbOd6Y6k/xAfSmTCVpXZi2hMlrC7WrJLFzv8AMBG
    fpU4mmuir+VHERwqu+cfUDvS2I3b2YkQBiUC9T7mrsIWGfcASkhwzdCD6mpsXKVtShPaCQK9wolGedw2qPQ
    4HWrdrpNuMFwWPXAGAPpV+Q2yZ8wfMRgKFyfxqmUvGYRu+yM/6sjqfY+lCVjJybIJbeCC6IdIxE/8AdUZLf
    41Ha2klvKJIleKEnPlFd2z35pjwTLMZHYHyXABzk57mrH2t4lZjuIbuWyDTBpl24eSMZuIlkT1XGfypjpH8
    pRni46D/AANQ6dO05MDDbt+8WPJBoWCZBJu2lYgCOoLAnGOaFEWzs2OJeBTIU3RjgFfvMfpTxnyhltzscsQ
    ePpUtuh85GflegDHgH1qWfTpS7PaywsmCWAPOfaqSsU5JPUZaJJHJujjQgj/Oajd5BN8yjcOhq/A0MVquTK
    kp6oTyxrPnvPnG6JVUsVGOTmkJSu9BdoaTdgL1IA45+lQw5fIl3xtnGWHUVbQFRHlTIpOOOMVR1G4lTdFCn
    nSAbkDDoP8AaP8ASixV22Ryo1n/AMfBzzx70CSW6LtGgCgZ3MMDH061SF+08TefAY5RwRvztbtgdqsNMyFF
    e5KoRtlAjJB/2T/9ahLUbTWpj6jKPLkgvXIiI3YU7QSOh+lSWl8t1ax3KbY4AhEcQGPqaz/EG97mC4TCrZv
    vaJ4yeM9CBx+HaotWvUWSRltvkf51CIw2sx6EenNOzWxakmtUaVleedd7WkU2icFSM8+lTzokZRmZSGyd/f
    A6cVn2qm0g8sQudh2l2wFJ6k5qzZPLJueQiOMqVCKOSPXPai435Mk8vDHAIGPmqnGGgYBgMEEBgc/n6Vpsq
    uhWR1V0TKuf4vaqku9MSxqJWU9V5GKxnG7Gm0EZjjm3DI3J85HHNWrdUmiYNIcKPl56is26l3XDqzAtjIbH
    A9qLKZ4SSy5Aw3sQRQ00Jlsxl4ny7bcgEH9DSo25wzHMsYwCeppkkieQXzlD8pHr6Yqw5DwoUj24xz36VFw
    k2QoVkQuUw4JJU8c1MVHlbhkj69BTZEYxo2CZFP7z3pC5T5GGATwe2KZOos8SCMqD75qkq74wR97OOtXJgG
    i2qwDKR+IqEIEyF6rQMpzsTGSmSVPSqihVkyI8hxuOeuatS/u7hX3YVuo+tI6kbBtyFYjNAyo22OUnkRtwK
    ihJ8t1Y8qcgY/lV+fa8QAAzggj0NUm5VZVwHHagTPjMda6nwjaZ/fEcnpmuZijLyIoHU16LoVosEKDoBXfU
    dlY8mlG7N22iUL7mtuKHYsbr94cYPesq2GZhn7oFa8LAqwcHHauF7nqQXu2LUjMIWQjBPYU+0h3p87ZGM49
    ajJctkDK9z6VY00B4iSeVNQzeBfSIQwBgu0n9Ks2MKm4aYpnPJPeqjv5xAz8oq7GxihAU8kVKNGrmlNP5ke
    2M4XuD1zTbK3MskY7DtVa1RhzjINa9kuMP0Hak9Q+HRGzEqpCpJwR0FSQ/vDzjn1rNExbktkd6njlEduHk4
    Yn5Rn171pFmTg/mO8tru8EhIWFh5QP6k/0qWURRT7YgemAKivbow2axwnc2Mgj1pNKEso+0TDBxwvpQ5W0H
    GDWrLIGUYSxBnxgA9APeqWkwfYriS2nI5O6Jx6HtWhMx3q7cbxtP9KbPA08EUigBUBRmb39BW0JdCG9Clf2
    ipKWO5COcdRXN6xcSefEUaQ7m2sAAOPWtq4uLmOQwXS7lHAnHTHoaWys5I7kzhUJKlfnGflNJ3eiOylK0bs
    xobJ3mXgBsZDHnkGusjslvUiknZmGOgPB9RWakcdncwwzMNu7KHPUHt+FaUcjwGSJMeVgyJxVJWIxEuZ3js
    c/qspsrG4i2kLJvKH1GMVW8Hz3F7bWcDuFi2Yk9dg5xWzrNgtzapFJnAGRj1rH8HwCCC88pczl/JAznaBwT
    RrzEWjyX6nYphLuGYD76lI4+4A6E/WrN1YwyKodnjkk+VVibAXPUn1qf7PFFalOA/wB3ceWOOhrKvbvO5Cd
    srgIP9n+8aHuclrsz/D9nuhvrsbJZvNMKSqRkhOOnQg1atjG1xNC8SRswBPyjGe9WvCkaLpCrCow0jsPxNX
    bqy3K5X75+U+4otcL8pxN9pn9p3TXNsiqsLBSWXKgdM/Umo4LIQSeSU2SNw9yvDsv9zb09811l1Yx2+kwjM
    i4YK4U8df8APWp7+JpIvKs0DtjJA6L759aaSudDrXVjmbi3065K2U0yLERuJb5So6DI9c1S82fTdQljkgSK
    zeSNBG44EnTK+zDFXpdKa6NxHqDeZIMESuuc+3txTbm2aHVEF9IbrTfI2vEwy4ToGB9vzqt9DCcWnzXGapp
    Lee0j28ttIcHczblc+nHeoJDcW93E1/A0bKpdpJFDqB0Bz1A7VvaLfztbmGZYp1jG1CJMgKO4PcUtxOYr0h
    LffA8fkyRth1bvwe1Ta2hrCrJ2scD4huFhv0Q4jAdpUaNsrtIxgH9a6Twi1vKqxXkSvcygkS7uq9q4rVIxa
    67+5WR7QXIZ7Z1O9F/w7V0WgxC4uI1tZPsyKCVaRsbQScL9aXLdnVGrHlcHud7bWyx3kbRFhJ5ZjMZOflHO
    aTz7qS/SOGNmJIzgds063gl0qe1nZy6SNhtw5yQf0rbsYRcTS3LLiKNggUEgkjqRiq5bHLUqWu9ySQWswCT
    3GJOhQNgH2pdQkjtmSS2iyFADHtirEa2zN8hUBshYwvB+vvVK4jaLdExISRCY17D1FBzRepkQ3P2ZpJCE+z
    u5YoOsfbPuD6Vbgu3OwALcK/3cHbn0qHU82On2stpErXBAION35DvVgXUFtpzyWw+1I65uJ+mxj1AH9B0os
    XKWl0T2l/LJGGuLq1tJFyWBXcfzPFUr7VJLSOTN0925UnIiGAvqMDn61NY3VkdN8lo1SBusqDJHuxPark7b
    YizKwh2mNQoySP6inbTQzvyv3kcfb3eo3OnNLalhaYB81k3MxJ6H0Fa+nicoVu4ZJEVdxED5YnthWFaMWnz
    3GrRi2jUWcrZORlflHoK3IdIgnhSOQXCyK24ujYGen8qFEUqkUZWIWgjksvtEd3JjaLqMqVA7HtVy8N4RGs
    8cYkUZEa/Nn6VuSxhrQwYWeIDB8xgd31rz7VdQ1Wy1USwRJcC3GFWOQExrnHfqaZjBubNUWTXNz5cssySfe
    wpwFx61qWcEUUfDF3YHKlsZPrXOS+IbdImaZ5VnHDIy/MQfWss+OdLtrlY7jCkjGxSdw98dqRuqcpI7r7P5
    Y3A+YWP8XUe1PubVGVmEZTaM5Nc0niRbt0McDyo4yP4OOxBrYs0mvUeKeb5SeCew/uj1FFkQ4ySux1u8nlO
    bf5yBjjt9Kg1HTHktGliDxKg+UoeVP+16/Wrqj7DLEtvF+6znap6Y9aum/kkdUj8pIypLM56U0Ck07xPPrn
    z2dQt3EzSYUtGgJAx6+tXoXjtY4fs6KZzkDHU+rNWTeRxvqs6xAjYxAZeAR3NW9KjmeNrhnBkfhVx0UdB9a
    jU752aTYmo4OmORI6xDOdvJZj6io7uIXNujXMzAKgLvGMvnHyjFWBKsV5tWNZZWBdQxzGpHc/jTLm1XTiGR
    y1xNl5nxnIPGcelCRzykvhH+G7iC4hMWpsN0L4KgYUnHyv7nFXbGJJbnUIJBkpl4wTg7cd/asWGVoZ8BMqg
    O3jliOcflW74gkjfStJv7cbVnB3Ipw0mR0J9qI7ESXLKzKKJBJZiaQlOTmNX+9j0rNtrt57sxWgAjYlV3tn
    p1OR6U551i0203FQ5XywAf4iecfQVWsEihlnmVcKRsj/2V7n8abaLirstCBbKWJI/3lpnAb7xHPOazryWSy
    lu5YiHCkQDdyDk8EfhV1Z9to4R1WSORXZ3+7tPBX6muduro3V/PGvloYiCIz0I7Y96NGhXtLU6eCMTRMhXE
    eMr/ADq1C7NbuRwiHKqRVO1lZHHyhWxlR+FaAdJbdnYnphgB1Nc7VnY1bGTyfO2wZycH396Qxs8ZZgcgce9
    RyBoZmdCWG0cfhUiXfmxqrAg4OPpij1FvsRtKFdUKAEdM+neoUDhZBJySeNv6U45Zw5IxtGPWlUjzBj+LsK
    AKk+W2rjr0pzOPLxnlhg/WnTlsHIAIOUqoWLMcjlW5I9KARM4HlB055IbPrVBT97ABKdfxq/A7GNgyng/MF
    64qrPtknc2ynyz90MckD3oA+QNChE16C33V5rvtPDB9o+6Olcz4WtdsJlYffNdpYRAKCBzXVWep59CJdtwR
    IQ/flT2+lbtvbu4wegGSayLdfNnVem3mtqC4b/VIcluCfWuZ26nfDfQczEDy8ZVuMetW7C1kFyIoypVlJYk
    4x7UwRkyIRwV4q9GqRMCwB9TUmzV9hhgMZI6564qyseIjk8dBUBuWmlYrhQDgEelXPLaZVIJYCspWWxvFFi
    2GMDPygVd3SBfk+7morCEhGDnnsKuCIFiTnaveldiejJ9PZI45ysQMkmMs3am3NpcX0qIh2KME/Sp4yAVjV
    R7mrguEjIA5fpWkXbcSlyyuiH7IE2ZO7ac1fiieRjKmABwR61VidpNxPPNaFpkoRnb6UXuzOo2yGULNaTKM
    5UFsdwRUn2hZrZI2Xqg4FW/s6rF5j53YwfeqNmCgMdwuFUnbIBnI9/StEzG99ws4Y5Ascu0nHB9RUN7bNG2
    20kKnujcj8K0obOFzt8xdp+ZSGqW4towmJlG4dJFPFarUfPZnCapaz3FwN6soQ7lYHvWtEJZbOOMHM+4FT/
    MVYvVcrL5Mits+8G61hxak9vqNslzKkcP3mIbkCkmkzrcueGnQ2JZTLAWZtpL7SvdT6Unh+xisvtqruPmyM
    NxH8vxrPvdYt31cNpkImVM5Mh/1g9cdqv6JqqySmGZg2wDKEYK560010IlCXKbryL5IaU4kTjaa888Q67BY
    64ZLtmEc44K88jg4rt9UTz4mC5AC5RvQVzU+kWs8tle3UavFkqImGdo6En69abi3sY0uWLvIteFNbW8s5PK
    jlTEuFB7D0rt0V9ikKQSOAazdJ0GCzb5FVY+o2DitiHzVbkJJxgY4NVaxFecW/dRjaukrwPHMrLDgZYdc54
    +lX7WaNbdI0CuVPG35R9c0zXrnOlzxlHErAKFPDYzyR61NDFE0TeQv7tQAMcZ96DL4ilPPB9ouVuQHQsuQO
    B0rlZru1a9MKSPHHsZdpXp3AP8AjXTzQxPczCVSv3WJ68Yrk7m0j/tp3lCpEQGUPwcDg4Pai8jelGL0ZiRS
    f2PqccsM5tS3zwQuwMcuPvRg9iR0rrLa80690tp4vMjkc/aQpUh+D0/+vWDrUcMdxYwOFurVpSUz9+IkcEH
    vg80/SpFkvrqzW68qa2lYJLCcqc88Kex9PrRe5nJOMrLYqeK57e6uJJIp2RpocFmXBJ6kA/SqejRzadINPd
    7e4sXVJTcMSGTIzyPYmusig8+xmsdSt2NwrAloxuIzyrgdcVVQTmzhYBZLiOQwGMAAg9j7jimkKU7tJbmtJ
    qcxi2me3kliVt0eSxBxgNx2Paui0+HV49Iil/0LeVBUbT09zXmkX2Oy1RGbalrMRHP8uDHIejj0Q9x2r1Pb
    5FoI4ZmDxqP3e7zFbPcd8UupM1ZJIxhf3NpLMZokQEiX5mGc9DtxWzdRT3EbLNJ9oAj3jHyDd2GO9cvfyMt
    +6zrgugXGflPf/IrY+2xPpscNk4BXJMbHqR169PalsaunomiW4uGn0+5kjDpJGggjBXiNj1rOvk+yaXDBFD
    FJCsOGTcVLepz9ahkkkitI5bnzYIppmMkTg9jw2a62fSrQ6Om5eQmUx1LdcUzOTVPQ848M6ffrqU9pLGksR
    AkVRKdsYPr68V1F1e3K2Zt9KS9mniO14hEHQD1DdxWnp+mR6XE73SiTf+9kB6gdAPwqKTxDbWEy2ttEz3Mn
    3NhGY1Pc+3tTtYiUnJ3Rq+GdWjttDae8Bijg+WQeWQd3tVq01WW63TCaCCJ3wkcpwQPrV2zjil0+KGQu6le
    WlHz7j6jtVZtC0qCNXlaT9x82TKeD600cbfvXZK0iTXotEvQ0jZLItvnj3boKxPEeh6hNDcfYtSSAbQQxjR
    WjPqCBye3NdC8UrwBrLUJCSMqJCCD+nNZNy09mXk1BFniK5d42+6R/s09Ai2ebXXheTUnEuq6ld6kgG3bHc
    lNzDr09K851Tw/EutgWipHHEwLnd8wOeh5ya9c1TSTrLQy6THb2EEjBTOu45bHUjis+08JXVkzO91GoLdVh
    AXPqe+Khq56FOdOz51qVNM1BIG+eO4ubdQB5yKSE+nHNdd4e1j7RJKAJFVT8pZAGI9waIdOmSIpc3ERjxlV
    yUBHtjtVVhYRyMb6JnRcfOrs59sY5qiZNSTsPg1jU4NfkM8af2M+VIA+ZWPTn0q5bym5a5jYrvU4ynQisy1
    UTTGOKdpYsmUxmQ78Duuf5GrlpIluJpEOwOC22Tjp2B6VKVmN2S0GatArWcaxj9+x2nA/h6k0LcWERhbz0a
    Nnx5ecBvbPYVkWmpHxNfKdMQx6RCfIkuZThXPU7R1PP8q0rbTIWWeO5fMUbbzLtxuHoB2qraEcze5Z02J57
    +6nt0QZQxNuIAQ9gPb3qlfH7VqJaSRlaJVhfHPTvU8M8S2pit0dS5zIzD5mWm27Hc7+WAT0JqRxVmVbyT7J
    OgClmVg4AHUHisK+1IGO7dWItICfI3e/3sfjV7VJLm6WURMWCkYPUsc9Aa5TWUkl1qy09XC2sEga7k6J6hC
    frUO/Q0Vt3ubscwn/s9ZbfKsTx3YY447c05tWs42SylkKTEAHZ8zMCemPWs77QlxfylJo4VjUZkLZZFPYL/
    eNZl/fRF44tB06ZISAHuJV2uz99ueeaOZ2NIqLdhPE2oSF2s7IbHaUJkcrGAc59zxWppen+XEbpkBjTrJIe
    WP8AXNYkdjdXV+YwyRCzcSNgFzvI4z69a7NNNjPh/wA25keeVpc/O2MgdOBVRSaBuyuOgvZJ5vJjRXUKvzA
    cD3rUt5AIGXI3BsqP6VmWZeOYbQAy/KAtTsDDeiIczNlzkgqQP61FuZinaGhpRyRSgEYLj5GJ7CoJQokU7s
    JjGfTnFZ0k6W93OHYjHYjqT0H1q9Zt5sUcBAwepb65rOSsxKNldDWIWOJDyAWCnvTXwkTNjJOGDA8j1FWHw
    kxQH7pO0/XpTUhwTgZVRzx1pA2VsiQhgcfLyDzmptFija9UkZyuUB6bscVVbAK9irYIz1BqeyjaW5MULiMA
    Hk/wgc5prcmWqC2+2pftIqObh2HmApwc9fwqjqLRpq0yQBRGHbDCtS4uIZLdlbV7jaQRwhwKw7gxxMojPmI
    DlXIxuFN7ExTvqfN2lQmOCKMdQK63T4WKqOoxXPaZGchuvtXU22FVAvXPOK1qauxhSVkWli2KxYYOODWppl
    qqp50u7ceRiqBxJKoXpWvHtEW0krgelYt6nZTjYnVQW3H7oqwdkkWOh6/WqaSfdXn2p6AtIdnQdamUjojEm
    t4vkIUDOea1rWNljCqcDqapQKNmeQM1sW7L9n5TLHo3cViabCKdrBkGeOpqzbB3XBGcnJFNjxn5z1PatWyU
    KSvHTrQl1Jk7IhMZCjPB6VIkeGzty1PKF2zuxk1pQWxCD37+tWlcnmSWpnQiQlsJx61OjsrqcdO1XJlCQlA
    O+arrEzAsp57CiS5SVruP+1tJhdvGanRmt9soBKZw49RVS3h8p2LGr5LCEMOnSqi7mc422GXSIHWZkRlHHQ
    d6mW0EifIg2EdQT0quweNNu3zLUnI29U9selWIJWtICYyZB0FaRMpqy0Oe8RadEsRNqmJE5kKk8j0+tczZ6
    NHG73SLukkOwbxur0GQxNbtGBkn7x96xLVFVicbnB+YD09RWrRvQqKCaZVsrEAgsIxLjLNs5NR6vaMk0V3H
    OyyLhWO0YI9x7VvwmGVN8TgMOjHt9aSWP7RGQE3k8ErghvY0W6IHWu9Sjp91M0EccpBZzmRsfwipt0NvMkx
    f9yeCMZAb39sfrVLT5Y7K6ntbsSmZyRa5XG9B2H
    0qrdtIbQpJ+4DsS21CTknjJp3sKMVOR3emSi4+dgd3VAo4HuaklvIbYmMuC+clR1rm/CN9epKI7x5BbjgMo
    yzD0b0rqo0imlZbWNUUn5pCOp9vWi9znqLklYz77ybqKMXUT/fGDjlRntVaORbeJEkLPbk7VuScbT/db+hr
    TurZf3kEZIcj5ix5PpVeVYrxDHMn7udN/wBOxH9aCHrsZdxbSyajt/fASQnAVwTgHv8AnXP6tbbLqMJG8rH
    IIZyD09/pXRWUzw6rZafNIXuMOBNtzujxw314x9ag8RpaT3EAklkJV8FgM44PPH8qZcKjjI8qubm7sdZhm8
    xLtI+ViX5Sp+vQ0mqXt1A9pqltCiyM481UYbiw6bl7ccVv6la2107qIhmM/dQckep9PpWHrNlcLZeZBagFs
    DLdQueOlJaHVKPNG8dzpl8WW91pkV7ZS7b3AV7cKd8TA8DJ6itDWrlDothdiGQ3bRjdLtw0Zzxj/gQ/WuA1
    O2upVh+2xo13LxIM7SuP4gffA/GtLT54o7Yadq73tpuH7iSU/JKPoehzTexioq+pqadcrNdme7gmkMYLPE8
    eGeI/ex64NalhrBBFtYXuLlZMwm9GwGPsGz39hWDrF40FlFcwXdrdeWBEY3JV17Yz7Gsvwp4pW0vdmvQ+bZ
    wyF5A6F93GBhh+FK/Q0kk1zHYNrEFykyTBWuyxG9myoHTA96v6WcanZFRHHG6kuA3yygfd3H86xdQ1TSCHu
    NFzDa3CkiJgGDN/EOTkGoNJOpWsNtFp0GyVMTb3wU+nJwSPSm1cuEotWuem397FiUPKsgRZGCYz5m7kgDHY
    cVDaSX0sEFwXmgdF/c2xXIUe5P8AFWRo1/qVzbt51kkkq7su0m1pWJyWOOg/2RWtqkkwVd7pblSAyqpz+tB
    x8l3yszNc12702Gd7u2mlikjZN5IOwn1x71qeFbGKVWaeKN7hgJZmXJ+U9AD2HtWPd2E2ots8yXydw37jnI
    9x6e1dTpMU1sixxGKMEcMq4LjtuHpQjSpHlhZGgLmeG4aOLc69s+naqOo295ffOi7MDaw6bhWxbrcABlChk
    +Vvl61ehjLndKp4GeRjFM5XOzOegM8CxxtObdV6g85/Gr8VzEjsWkEjDruPt61buVSchJIx5Y6d81nXqPHa
    xpDkI8m3p1B9KErmbkpbmHqOofbLcQeQiXKkL9oGVC89x34qx501sht5p45m27jcKuQo9MetZ/iG2hheKSK
    UvLPJ5YBOdjDkMR7dKntbNlj2zXKooGSB83mE0zRRjYSJShwkfmRZ+
    +rZ2HuM+9TWIAMgRyZD91Sc4+ppL2zjjWBVIAdi7EPyR9Og/GqdvOY1S40+PdOxKBX5yf72famkNPTQg8S5
    tH8+ZYFuFTy49q7mOT2xySKzb3RJr+OOS7Zgu3yYrI/KsYPVnwfmbv7VftrPU9Svhd3lxbi4gYxxEDCoO+R
    69qnubExBp7i6dWbhiBhUAH8qTLSva7Cw0+2023ito5FlU4DLnGMdBV+6k8+8SC2AkIGZFA+8B2P0rBsLu3
    uI/N05pbibPzbVLAepJ6CrKS30TXTSWUNnAUASZ5jnn2Hc/WqWxNTfUZLd2dpchdxWLkNvJ5b2/wAKazyTw
    vKYmtbSP5i8hClgP5CsCWS4leE6jqEISFiVWJRlcnv71m6t4gs41uRie6B2g7ySVGecdhmlZFX0ui5JrMl6
    7/ZFEVirEBvuuf8AdHr71xOuXU11HGkbypDJMqvHGfkXaeCzdyeta9st9rtubyTy7LTY2KlF3Azg9QGxkcc
    E1R1ado3jitVjWJAPJREPljrweOe9GmwRSk+Y6ez06z0mP5UVZyMmXq3PcHqTWTeXN5FHM9rIBcKMJ5q7sF
    jwAPXvmrtncTWgNw4WZ/K3vIVYgAD0I4A6UaalxcXIuvJlWIxGQfIBuOM7jk/hUShfY1Urak9gJLPTxG9vI
    7sBvdXGZn7sa6K7ux/Z8MW0oGUZXb0x6ep9aw9OS4vFV9gVggwXfgfgKtXksUiJZ24We6U7nlP8Ht/9alB2
    CcrtWNGDFvLtVGkb1x3xWCLx3125ubdQ4hOxQzfKpxyeOpzU15dSRyy21qW3PlTLjoe+KpIIoWkhhQosbKq
    nPIwOWqW0i1HmeptSoZAZXYuwO5txGCx9KuR42RE8gqQcVlZKwrP91OiA9WJ6nFaEGVi3KTgAlQfaspdylo
    rFsfIUfPyggZPNOaXy0ZZD7/jVGOfZuypJZRkD2pkgkZgJDkH8qSFKOtiK8nWSYrGQSm04FW9PcJqImlLKm
    CGVRnjHQ1jWlkYbm6Yu7tISQD0AA7V0UOo3VtCIy6YC8AoMj60LcUlpZEckWlsWVHu1APQKD17Vk3TRF2WH
    d5SEqpfrj3rZk1a9jULlA2ASdg71j3Tee0k8oy7klsDHNU2uhEb9TwjS1CgEjpWzBKfNBH3R1FZdtHiEEA4
    +tadqBtcBecYqpt3uZU10NO2Usd4AAHvWjHlkOeG7/Ss60QouXByeh9K0WmKoCxznjIFYN6ndGJZjGFU9fT
    irkK4Ujbz1zVdWUIoHJq5ZDLNnJHWobNErFmNNyjnFWrdgRt3dKgwdxCjJ6gVYtxk8AZxz7VDRZaACpkdB2
    rQtstHznJqhCu7Cg8E5JNa9qCgBPQVUFcmT0J4kYbVYdOlXzOI8A8nHaqN7cIkW8ckdhVW1uJJiXIwtaOVj
    NQcldm3ABM3zfdJps6rExVeFHSqsEzYwAc0NKWYIevei9xWFyWbOeKvxvtQAcqapH92w4w1IbncRs6A/rQm
    JptFlVZZ2IOUJzjtUjRrJcRHlWGWbaeuKVJAHXcBg9ar30wWdQmQGXGR9a0VjKSbFe8Ec2y6iCbuA6jj8ar
    6lHHbRLNAF8oEGaPvtz94VOJjKNsiBogOc96rPJJZx+UFa6tpARsfDNCD1Oe4rVSRm4spXZhktFkhdVZ8kY
    6tz7d6Q3mLQpbB/teAOmNoP8R9RWHAba2UrGF3whkYA/M3PBx6+vtUSPPDI0E9yA0pDGVeSfYU03c3jBShY
    6EyWl1pRt7iEzSEMzu3GGH8QPb8KytN+3R3NuLuVZLVR5glHLc9A1ampG4tdKd7eIFVG0OTtJz/s1DokisI
    yZFCyMIpNgyV9cqeOCab1Hy6XOgtPMZtkMvmAH94wABI/u1eWV7c4gUFR/wAss8L7g1lyWTWMLx2gWKVGwE
    ZiUc+qnsaktLmYq8dwDEAOVmHJ9we4osc9TU1YbrzIA4YtJ1ORgj61QuFLO0WGD/62EZ/Mf/WqxazRz28Yu
    VMLgAIxGDj61X1yG6gg4YSsPmWReqe5HcUamaOW8UX0tveafdojsLaQGUKefLPBBPYVuSQwXE9sZRlWfcET
    hTxWbeG0eylmSQSpcRNHdJgnEmOvqKqeF9VWV4rckmS2g2fOOufT16UI05eZXiaGsaaHntiHigBk2sVXJKn
    sfaufv45rUGKWRSTLs4QFcA5Brr7y386AOrr94Hd/dOazbiKCW5clSuF+XPR27mmxwbR574mFxIrSpNhwvC
    4xxmrXhS0h1OE2niK1aZ4wEJY78A8qRzxW5qVnbS4SQ7pGGAqKWqrK0un3lteQW6RuEMTF5BzjoTjt2qUnf
    U6KnJa8SHUNKiglkikWOazRT5k0a4ZGHCFlHX61n6VpP2i4nubYGaDePmjOCMDnr2zRqviMpJNJKuHZcbIs
    7hjtjv8AjVn4fRXEN2LGQwWE12HkAvySkoYcAKvQjryadlcmNWVJXRZvNHtL6CIy3hju4psbTtCc+oqtIZ4
    rmO3ibzLIHBmjQ7W5/hHbnvWB4rgvLXWgsuoxpuk2AxQhU46cHnHvXZavFf6dY2otLpbny0x5xYx5J54HTF
    NDjrbzNbwjr7JYmyuAzXEMzIs2OoZu5PoK63WtTVluEeCVvMjxglccd6868FSm4+0tefvJw+ZVYjcwHPFb/
    wBoaSUbAzKCRjHAFO4exiqm51Hhy5iOlTpf26+QpBUg5Y+mT6VomVIo984WPJ3Kc8MPb0rlrSUJYrBIWdd5
    IjY42jsc96o6tdzwWcl1FEs9yVIWIkn/AIF7AU0zGdK0mzuNM8RW2oCT7LmIwOUcM2dxFaEOtx3WTKreWpA
    JVCfavG/hFqEl/LqEczmOTzyzsw9ewFeqwwu8UqRtHGgPGDy31pXuc86UUW9V1b7NPBbwwk78s3QsFHt71z
    vinXHlextsNE0jZTA+ZSe2PpUmj2L3tw0kDMu6Zt1we6LwFH41FrEX2aJ1WIozTKWkbOTjuKdxRjFNW1FtZ
    XjvJvPCQqsO1ZJiCcnr8o9q5O51Wxjgne1ZmkDbEOTk5PRew5qt4l1iO4tr3948flrtedBlpD/cjH8z2pfD
    WiWn9lW1xdwPDdFcqhb5FXtj/a96LG8YxTdy/p17cTxrdXEc8l0x2bGYMEA9627KO8vbVJY3jjkmHlxgr90
    DrwPT196jS2jjkSOYNFawnzZIwcl8dD71t2aRBPPdWgDDciA8BfTH609jOo10GS6eEgjEtzLtUAv5fyk+p4
    rLf7LFqpdYxJAihf3rF/c4zWtq0yi2DwSIcnEjZ/1Y9/c1yWoTvp9u08sqQoWLyRuPmI9Qe1KxMH3Nae+tN
    PS9idkjgY+c0YIGcjpj+lcrNrl3c2sU90lvDaxNwzy7lx2IXuwHr0qLTrgahI91IpWGY7lXtgdDk9zVzUES
    SGJ70eZlsQ28agZb0UenqTTHBX1KUl3HI7rpqQfPH5i31x8yD12jufSuXgtppr9DcsEEueDhjtB+8fRj2Fb
    Oqw3MkwtAYmVcO0cRCqnooPY+vrVC+nlj1Lzbpts/lKMYyZD6gdhUza2N6UOaaUtjp9kUdrHDCrsY143HhR
    WBqDZ2TupLklI9nfPenu0z2Eku+MFSAFkf5mB74rGv7lQVLTSXFwf3ccMZx9SB0A96g0lG11sbQktnhaW9u
    DsVfLRN3XHr681b1q583S3jjjkCEBldflViPc9vpWRp9hcTcxrbQyE/LGMN5aqeNx6cnrWlqllZySwTX1+9
    8gXaS74XcP4VVe1UpOxk1eQ3STJLaRmW5XymGWK57frUsWoJHalUUgFmWNF/1kv+FOmvPs1osek2JaSVNrP
    Iu0H3weaqWVrJby75WRX7t1Kn2PTNZz1Wh0RjdNsv2cUot2kuXSJck5zhR7D2rNj82bUXaNW2FRL83AJ960
    3QuckCWThGd/uoOwHrVkxqPsm3fIN5Q7hgnI/lUrzJs7ajY4Rui8+Quyn5TngfQVpxoREUY56jj0pi2yiRW
    kHzLzn0FXFRCsrJyo4+tQxS2sirECnzEhs9PepHQ+WMEEk8ClAVZSgHA4zT1wGAIOApOaES9dSFUxGoZfnA
    JNIAo8x3+ZWHBq0FGIx1JUn60lrAk8rRysVXBZtvXAGeKZLdigHEsygsvp+FMv4EiiASeOUhypKZH860ore
    zgsWuLiJmWeTZGN2CF9frWVf2YiupoNxKxsec84oasgTuzw8uqBV7Cr2nKXO7OA1ZW/PBrV0w52qDjPeqmz
    KlubtqAUK/zq5aqvlncuecVQtiVU4yeea0rfI6nPpWDO+GxdjjGABV+BVT5hjpVQEbs9MCpoSwIyKhuxdjQ
    CKIlYH58UsSmN2HZuaQONpHJ46UyHe8i/KxJOCR0H1qWVBW3NBVXGQOlWIZHYsDkJUVuflcMMjp+NSIQUCL
    1zmmhNlrAaMBhnHIpy/INq9D2qFVdZBk8etS4G/luvSi4i3Zld7Bs7cU8GMS/LVYbkK9wTSAlJfvcVVyeUl
    upXeQgcnPGKW1QxlnxnPY1GDuLFfl71ZjGbRyWOQc49aaQpPSxGHbzSzHIP6U9VMhUuPk5FJbBJYpJPu7Tt
    Cg4OaZLcSw27h8sB824DkVaIdnsW41Kxt6fSq0cgWW5LEfLtGPY1KkyTQBo3yCOo71TlA2vKDk4CkiriSl3
    OUuI7c6xqJl+SGBTJC69VkYcg+o9Kl8iWEILtg4gVJAVH7xATz7HoKqzJnVDEBjz8s5bnlTlasX7C5v/MeX
    yVjXynbsDzkf4Vq5aG1Kld6kur6vILGdJpUOCCvBUtz296LFJgbKaZ2t4ZEyXdQ/znnPy9MjHX0qY31vDpZ
    iltIZLgkMJCM7Rnge/HNWbOWC8sYfLUJuC5wO2fzpJ6Dnd+9FWRsW6XM6xO+otcW6EOWG1SmO/H9almHm3k
    MtyWCbiEBB5X+8y9QaorYzxkmRnlhRsB4R85PuOCRSa1cXkts6Qyw3Dkfu45EMcgPbnpVptHE7SkbtjYu9i
    08E0ktrGxDIrcjHXGf5Go/7NvLz5rC/iVNwyksZO4/3Dj9aydCvJ7SJYcTQ3t03Mcg3gjvjHWt65d0Vmi2w
    gcMkb4Z/XcT3+lMxkrOyMrxHaXtppVxdXEMIniHMlnzx23Ieq15p4fvIVWJxJ5VxCx2A8CRc54z754ruPFe
    tLa6eJLeCVpB+9V3YHGPX/CvPPEcMes2EMznyNxGJF4Zuc5PsKNDopRmk2j1mDVluooldFKIuQeg+nvWZfX
    0c98IYVjhlk6SyHcBjsFHU15Y2o6nZXJtJpJbhbfpLFnLoehUH+VdhpPia1hjiLtmSQECTYXdeOmO7n9Kd9
    bFShFRUovc3JHktYdtwHjaU4ReBNN/P8hWPrlykdkQ0KWsbkA4bMjc889fyq/FY3l7bJcMGtEkQEK8m6dwf
    7zDhR7Csa4nWyu1t4Is89WXgY7570rmajzanP2sllFei7t9jx7vnLnvnvmuj1q6t3tY7hGjm3yBg6j5ovYV
    h3ViHUzTMpBcsyY+9zxVyxlt0t/tE5C7TtKdsH0HpS5Lu7OlSg0iZtMa8keW+eOTyR5kUcq5DkDIXcOmR0r
    R/dHSoPNHl7juUEf6oehq5DHE1us0coeFwFAI/UUmuSKLQ+WSu2PYwZRh6fcOa8lbYi0CeOEy/ZrePyo5AJ
    JFIO1m4AHfmunmaW2uZA1l5XnYTGQArDqfxrxvwy6W3i5Yb3zTEQRiNN/708qv417LFeW5VJPtRBjYIsU3J
    HcjnpzUxqLZmdR2leIkmn3El3Ik52hRnEX0zjJqpdXX2X/RzAUS5BRZu+MfdPrzVvUGMi/611x+9LIfvNng
    P6VyfiTXJLmARSQsbiMfIyN8vPGTWjvYXM3q9kR+B7+ysdakil2lTMz4XhgeR+NemC5+0mRZAIraND5iJy7
    HqFJ/LpXifhi0Sy1qK5juTdKjtHFIo6t3x64ya9O1nWmt4ba0iWO3d2Cx+rj+Ik+ppRTMq7i7NG3bzS6daW
    9rkxkRhkjA6sef61lX9y13I7OUU27nagbGXYc4P8Rxmsy91uO7aZZsssC7gU4Z2PGM9QKn0DTtviFFublJJ
    2t9wVMYjB6KO3fnvVcpg9LEmnRPbSrcX6JI27dDC4BEY9fqa17qA3Ucc8DRbhwUA+VAewH9a5fXJ7i18XvY
    RbnZrcEyE/KhJ/wAK7DTZbeyheCT995OQWfnLGndFapXM64uyLkW8aBYrZQjv3LHke2PapLydWERDEbAWYg
    8HHUD3NNsbm1RbwSxzKWnLugxkDH9azL7V7iKwMqQJHDeNvUPyqKOB7k/pSaDV6JC3N5CE89VbygC0SZ6gd
    WP8smuEv726168iNxGhtXfZaRs2d7fxO3+yo/OtjxRdQw6TPDGXFtgM/wA2Xcd8e3XjpXN+Epvtl5JePKWf
    Z9ngjYgJFH1yT2z7U72RMXd2O3le3tNLWAWokKr+6BfBJ9SOwrM0+0ujfSSi5kFwoKzzIPugjiJAen1qWaK
    CEg2lyk91kFtg+Vfck+lXDdQW6CINIxZwxcDG49Tk1N9DoUObZCJps9ppbCSYCRXKqpjBLE9Tn1965n+wru
    73zTXqwxQ8NJIoOB2FdTNPcXuEtkVQhPvjn34rG1iyzbyJCfOdyQ0kkmIYz7Y6n2qb3N4v2atszl9TtJLTy
    YjO7TykOsI+Y7fX2z2rTtLW6hjYSRxwzMARv4dFHQAdBV7TZ1spUihjQMieW87nczD1+lW5jbrCyxK0jTbg
    DtJZz6UnLsRyuT1H2mnW1vp0tq1qJNkYmuZ3m655zxxk1BcXsc1pBFbQR2Vs4DKpYZI9sc1EunwqUSdQwc7
    5o1PU9t3oM9q3LPToLSUeXAjS9gkZIyPSnzaERhFamRC927q0aiOD7oYg5x+PerdvZYiV7nBKE/vJW6D2A6
    VrwieOVi0a5YYJk5x+HrVT7O0km0Azu5+833VPtWT0NUyqsLXch8vIjU7Rn7z/AE9BWq6CNHiwN6jcMc4I/
    wDrU6ytGtomkRwHB6nkmrFpZPGk0z9epz1Oahsc2mMUiaNWJwpAI9SKkVGESqq4zyTRaxbAsZOY8kK3tU87
    YTcM7ehoSM3e5XUEE5AUE8e1I8geUrtPPyVLMBlnJ/hBx70xQ5ABOGHJpAGd0jNnhBgVDZmaPUFePmUnCqe
    QwPXNSEBVCjjAOTUdhcbNU3zNtTY0Yf0+Xg0+oNXTLtyblb20/dWpPziKMHKqR6+9c5cyyyTyeZkSMSJCex
    z0roxp0gtbFJJosR7meTfwMngj1rDu5hc3t3NGuFkkOPcDv+NOREGeBwHegLckmtXTshgw+6OKyLIFyoHHe
    tayIA2hiOeaKhFHe50lmymGTIyccVdtlLRqSQOO9ZdrlQMEFTV+cOI1VerHAx2rCR3x1NCFWYZBBBqzH8qj
    Oc5qrZ5jXGQSOK0ISrEb8c9DWTLSsTltw4AxirtkR5bPnnpVHyijFc5B5q3DsCbc8mixo9icOQAqnkmpgxB
    ynpzUMY2Rndyc8VIjhAcnHrQQtSZJMjG7n3qSNcn52HtiqJuVjmjAUfMcD3q+RufIPWqigasXE8sR5AyR1P
    rVN5Fa4LKPlLkD8qjkkdECIRknGB3qORG8pMHBVsmqZKjbcvK4K/N0FTQYa23oScj5SarRuGVV4wvepRcLa
    NjGbdzz/sn/AApxZMkLCxjkKgEpJz9DUs0ZEcuQfummO6MwRx8jd6smZEhKyNx0Dj+RqoruRJtGI0kkUaGA
    YOBuHZhV6FkjsjKwyDg7c9DUF8P3uI2yB97sMelUJr6OCGWBG2xnJJbitYKxoouaVjm9Vne3nuJwpZYZkYs
    hHcdP1q9ZeVJqXlXatHHMoZi4+Xfjvjsc1maxObjR5Ht4gqOmHJPJAPUVteHQ09pNLMil2RAyj74AHBH86t
    oPa8rtsTahFGbabyjGQB29qz9IE1tI9vBKFct5YDdACcg+3FbS/YpkeO8bZP0+YY3ehFZNxB/Zmp211HIss
    MYMbZPXI4574p2HKrdano1kvmwAnaiooXOaSeGNbaRyBLs6gdayLO/gkKwh9t0OqNwR+FUDq9x9s+yeTtEj
    YeXoQvfiq0OX2beqNzSLM/aI7y5YEvysTjKqvbHpUviW8lsLdiym4tz0zgkfn1p9mUeDy4nJMIwN3GU7E1z
    fiu/u1sJPKzK/SJD0JpN6EQg5zVzCmnttTMkFrNsVh5vPI+mO2TWaIFvdJgKgCWNSrrjgEEjge9M0LT5LdT
    JcMwlYb5VYY59BV6HWbXS7GSERK17LORGrHPzHoT7DOaFZ7nXNumk0clqEkwgPmO5v4Wy5U/MqDoRW9pWn2
    sl9Iwn/AHksW5WOBtk9BjoPers+i2MMEkt8zXUj5DyocGVyO3oB2FVfDt5YgRW93CgvI3CJzhn7Y+tVFcui
    MJtSl7TodJpdzLa6fmZle5jc4AHUelVry3a5jMsiqJnIwQeF56Cugt7NYomeOyZpiPvY2j9etcjrh1K1kM0
    TbIVI3KqZ79s00jN1VL4TP1eMjdaxpucnOAKx4zKFvJXUjyz5S8jjHX9ai1U3rpNeAyxqqFtzMAT70eD7K7
    vbWGaRZBDIJP3rsAJGHIOPQetVa7MpVHH3S/YX01nMlpIT5m0bFdskt3wPpXT68Zn0dLzCLHECX7ngZNcrp
    Gk3F/PNrayItortbQyuceay8sR6A9KvalcPLoS6dHuWe9uEgWPPQE5Zh+Aqbam8Z2jzr
    cyrfRytjYapdiVhc3AmlCMVwD0x9BxXb24sbWB5RbiWIKC0Rbd8zHqG65HBrnby9iOtW2nCUS2aOhAB2BSD
    jHtTtSt4YPETRQNMTMSscbnlj1/7596FCKGqrktTpdE1We5uZFmiEls4IeWUnaePXuRXM3dsniHxkbeweSO
    0tYWWRohhHYf3vUAcn34rL1a7uYba2tIZAs8hZo2zln/vY7BTXX+Df+KYs47Pd587qHupkGThhnb+fFWrrY
    56s+Z2RhXkcuhXeIpv3drHuYJ9wM3GfyqnpGqNqc817JcS71m8m3U/MI/9rPb1qfx7LK895cq8MKmFGNtG+
    Rjvlu5yelUdI07zbGC2tyq7erlsBj1kYn6fLTSsDanbodT4fktrO3nuYW8yG3BkeSQ586Ttn2Fb8QhtF+1v
    IzXMrCaTHZCOFHvXITQx3KQaVZyQNbPIZ5zG25EA5Vd364NbGhrc+INfc2kr/wBn2xAaY9JX6YX1wKm9wUU
    lzHc6Zp73MlrNJBKySfNOcZO3rjd7cDH1qTxPrek29g1palYcqAcr8xYnAH9azrjxNbyXslpZtcFLJSiQwf
    Mo2jqx6cmuZ1y9vb68iu72OODywAsEZ3u7HnJ7Lx680JGUbX95mV438TTWdpKtg/712EfnkfNuI5IA65/Su
    ftNf1LXJreCOEkRxCLlSAMDjGeMnrVu/wBQ0mG+tzqYkeaKQtO3mAMF7Kg9OmTWdZ3Ul3MV09Hi8xvv9CU9
    Rn8alWvobuXyZYfS21jVbayubl54wQJ5Vbggcn8unFegRW0NunlWCQ2trGuFZsFv+Ar1/Oq+i6RaWFmk1w9
    rJdSfdbBZkHYY6fWtjybSKEzSTu5xnI+X9BRKV2TGNtTC1qSGHTnSwtZmnYgo7Lksc9ycU37aVtIXmQzTR4
    zGqElj0wMVelhjvwo2rHEjbmdjlyPQHtWjaX0FlCXtbaMrsKBiOMY5x71Kd9C2mlozBSW/u4H8+zayzwsY+
    +B6n0qQR20FhLDFbTTlPlRZBmJG/iIPr71r2LXeoKn2xEsUAyZJGJDAdTgd/rTJRFAyKzGZAxIXouO2Fqn7
    oL37LqY2m2nlGZUAFwflIXgKvoW7mr7232dfnlkkYfdJY8Z7CtKK3BQyfL+8J68EHtSQQfaZQ0g+WMED3NR
    I222KlqsES8RK75J4HVvU1qzy3MT+aqZfO3KjjFS29rHBuWVPvKKnnaZogQhC4I6cFe341F+5LavoZZt5A6
    vcNkbWIXOApqe3jRYshTgDg571LOhedPNOV28D3xSwIZIG3KQSu4e3YUutxtjF/euTgcAD5RwTU0ygKqoDl
    euff1p0MQijEYfOfmYDufSrGwKiyvldxyVx+VSQ3YglVQgyoViMAD1qCKJRuDuWZjg57CtCVTuUrjA/UmqU
    mEmJHcc896QJ3VhCqPglcIGLH3x0phBVGY84B/GpJmHl7cZ3nnB7Co5n3R7kI9MU73CzIGlVMoUzkBQPeoN
    Ot0lujHKpaNFYtg4wMU5+rE5IUZBPc1FaXLR3CmBd7sxAQc7uOaS3G9i7DJpfmqPssqgnCuXqtqdpDDZXBt
    EeJ4GCOhbcCCeoq6IXjzLHo7CXO7DPlQexxWZd3U5/0J0VLh5C00mc7iOce1W9DPd6Hz5p6/vkVQfT61o7Q
    k241madLtkU88GtVlLT4P3TSmKkatu+UXyufWtaISAK4x071lWWEbaBgVoxyNnHYVg0d8S3EWUHPr3q/CQo
    BUgk1RK4QZ781Og2qn51mbLQ0/PPcc4wKRbhVJZuo/Wo5FDqhQYPcU3aSx+XAHrQNWsa6SrJGhp0jgRBupf
    ovesxZ9iq2Mg8AetJYyykM7dQTkentQTymhHCAwYsS57+lbMKusIwu4+p7VlwvldzcHtWokqKi/NnIrRImo
    ytsCT5kYFvX0p0+NwwMqe4ptwjtIuORnrUrOwQoQCtOwW2GAKsRA71NEQybWOQwxg9DUEJG/LDKdhT2IG6Q
    HGO3vUpDkPgUW8yRsGfed0JPU+oP0q3Ml1gxKkQJBGWbOPwpkasoDEg3AbcDjIHtVswGfHmO3PZeMf1rVHN
    J6mFAhikKz3QQYzlVwR6jmsTxDp8typa12nZkiWXjd9BXWTxJbXGIkQAjBJGQPeiS1WdGaHEwXjew+VfoO9
    aFU63s3c850+3MumiK/Zo9vGByzDP8qv+Fbya2vbu0uGaNLYDZOEy4GcZI9K6dtMhhWVyFkZzklhyfauXni
    m07xHZyQAuJQY3Vvutjtn6U0+g6slUfMb2pCK5hSGWRpXky3mIAQoHfjpXIGBY73y3kcQruxtbGQfboa0Lu
    6vrW4hewJiVCQ8cq9FPceoq7q1odS0+C8gRHKg7gB+Boba1RrTjFLlfUbC502HbfEz2wOEmUENH7MOv410F
    7HbJaw3ccpnDgH1IHqCOv0rL0C2lXT2EzI+zC7D12+uavGKazVvIB+yuvzxFMgHsR71Su9TKo+V6Mlsbua5
    kSC2BOeQxYDcO4NX7hY50VxEzMrEDBHBrJt0a2vImnjeF36MF+X2+arTymK+ZWkXzm4BY/uif9o9j9KaXcn
    lvLmW5FqFxFYtBPdqYoM7ZWkUEbRz/AD/nXN3tvb3OpnVtTaK3SYbkiKbdqr049Twa1NXlGpaiIL+JmsoFM
    ryRfMruD8qD6kdauajZw38sF1NmVipKxg79uccH0FOxhFtyuVJrSS8hjuIxvi+6gII/XvXPv4enj1S3uo3K
    zpKGGVyPwr0GG3KQfvWdOPk28D/dx2FYyXLy6gyuA0ceAsqj5c/T1FW43QlOzs9TZk1VxAiSIZLkjoBjHHf
    0Fc3q32i6V/LkUTZwePlUew71BrNzdWt2FtmKw/xZ531kpqdzG0mHPlyZRioyY/f2pRszNrk94y/EEMImt9
    MmZ9txL+9lLdEXkgfyzUFzrLTSR6XoltLNPJuXbEpKrFnlV9u9V724l0iaTVpY0eaaJhHBL842Meg/ma3PD
    c9tpOhNqVuTNqcpBbyjwsfdAOo/CiTsZuV2m0Sme5XSltbi1ht7RACAeSMegHQ96h0iIyeIrd5ZUlt7BVZZ
    GX7rScDd9Bzx3NPl1zzrOdYoVa3f5Du+8hPXI6iuU1DUYI5L2CFjIXTMXzkkEYALY/SinFxV2bVJRulsP1W
    /MOutLGrxqW3LuXONuRub61oaTIfEMqXlw0kFjbc3tweSTnog79OnvXIX2oxRtZpZ+Y94wZJFUblJPc564r
    qNJvXFhb2lyYY9PtXwWAzvlbkufYGtLaGDlJysjstE0y1gv/t08Ky3124SC32EfYYc87ieN5Hp61q66iWpu
    n3uvyqRLnhvYD1qHSteNp5U8Z/dTAw7FjUmTHcZ75/Kud8U6nPMk0IuZhbqxJRhhY/xHf6UIFG0tehweo3y
    jW7ZLzD2KNu8sH5nHZfzxXa+GWv9csJrUSw2VvLu82aMA/L3CntXE3enrPLHdWyM4ZtqDoHIPJHeuhsN0Oj
    JEbqNrecmby4/vMM42tjoPbvTfYiF5PmJ9fliSxj0/QYkhtIFO94v4+3B7k1o2WsrpukLYQTKEUBppI2wI9
    3XHcselULfybm5WKaGKFpSoUk/cUHv6HFT6joT3CiSwgENuZiEfyypY9yo9Pes7a3NnJbFhvFkoeKz0dRZe
    XiHzCmNx6gKvVmJ7mrCWd+N9tq1w0V27kuvmBnz2X0HXJP4VFYaFaWiRI4llvYsyG5kYY9ce1WvDuozRj7Y
    kcb30qsqyTpiKEE4JHqcVqmZNpSuZMGju+tyWxgZ2BwXlX5s9uD0Fd5pej22m26hLhJ7kjdMyjp/sjHSqHh
    YCRfJt/MMc0m+SRznd2A55xnmusnsYtMs0Xz1bPA2D7zms2jpi5bS3IJbmeGAK1uSkynblAM49DT4zcSGPd
    Aiqo+VS4GCf4j9KgtZzJdxLflvs8Sl0GMsT2A9B61YUl4jd3JAiz8kIGQw7fWo5Ry0H6hujt0FlbR7QD+9Z
    +Ce/uazNLsbrU3Y6jcM1uFPlRQrtBbPHPp6mrd4st9GZ7yQxxow2wjqw9z2+lXbi4lt7djGu+RxxGOCqevt
    RyijqrMrI6C4cDb50aBWSUlvm7sKq+IbVBJZ/ZWZt0QZwR0P1p1jJDJZsYzGzsf3hY5Yn69hVprqNwRFC0z
    bSoVeij60pbG0ZOL1KqSSyXEEBixEitk4747/AE/rWjbxbLdGx97oO5rLsYHtlZJJFaWRuJBngelbywCW4i
    iAYLgdD+dRzXQvMapMnzznYpYDAGeKRpZzGiEY3EkZ7D0qdYT5UqRkny2J3Z7Cm3BkeQMFBVUyT7mk1ci9i
    tDtDAjKs2GIarcyK26McLnHHfvUUbRfunZWwQOPfOMVKoJilXONrAl/XJo6DuOSBYmUN1ckgDqFp12zsCys
    AF5JPpSBnkDyEfMPlXHfFLM4ETpjHmKBn+dQSyIyErnGAFzj61AYgiFm44JwfSnj/WBeoHJI9PSnsVeIZI+
    Y5JPpRYL21KYILoeAFQHFV0Q8R/xFiST2qzcFVDyHA5AA9qotK29j0wSB60ildkMjtiRgPlJwKn0jy4ryLO
    FlcMiE/wAJxVNpi+I1Gdp5FWrSJJZ1SQkIEaRgOvHpQtwlsXY0vHtolgkb7RBOwcZzx7+1ZF6iJq12YW+VG
    IX8auCewVFdLe4P0l5/Gs7dErSSRoVBJYKxyQPSqbISdz5+sRnOeD2rahBaATc7s4xXPW77XUkNurctp8xF
    c9+lOaJpM2NPcFwXGGYjNaMqmOU4OBniuetpmEyncQB2rdZjIiszZrGR2QbuXVkLbVPar6gGRfYVi20qlsc
    1ejlKso9Kz3OhJmhFI/njrjOKsXHyqCSSD3qCFuN2ee9JdSEp5aDg8CgB9r8xMj/d+6v0qXaTna2xqVYjGg
    XnAFRMSrex4pXZSZbjkcLtI2+uKtW0pzjeDj1NRwBAWWcduMU541S1L4XH94jJrSMUQ5GjHdbhHx061bZUk
    UFR1rgLzVvslwgnWVAx+Uqc5/wrq9GnWVA29tpHc1skrFyhpdF0AhiCQOwpqn/So0yNuS7fQdKfIhIJQjPa
    o7WPNzN3Kov86i1iHsbNogmhZu6tirMAk83GQEA5JrP024ZYHHQljV4nfasOQ+CRVJHHO+tym8RuppvMBW0
    b5C3eQD+QqxC4twbQBREF/d49KUsTbKR2AqvLDveNlPzqckf0rRCjrowu4mZD8mduMj1+lYOpWwuYZ4gBvH
    7xGc42sOldTPINisvT+RrkvE0k8do8kQCkHlvX6UmramtOLm+Uj0LUINR0sPKYw67lZJOcHOMf/Xqrp7w6b
    K0c25Inc8oWIIPasXwfJtnuhGw3O4LF15PPOD2r0NNOt76BXDbU4JA7Va95XQ5L2cuWRZ0zTo1tEeJ5DnPO
    3IxnpVbU7mW3GwyAj+GJ4tu/6kdqvWc/9n25jjDzRCVlCsc4NWHkhktpdzK8nUsep/8ArVXkcuqepiO1wLR
    PtCwyADpGcoP8T71yN/dR2bz+aPKtyMrHM+V3e3fNdrDbx3MkiWxCyIMkL0/KuZ1bRPtk00s21PLysSnlXb
    1z7VnUUraHbQnTs4t6nO+Hr/zbK7unklhvZRthiWQt5SA/5NdL4Uv4ylukCIbhSTKWXYzj1LZ5/GucsNKFh
    ozSujAbTlh7Z4qxZcWlk7glWUZVerf7JNWk7IUo09kdfLq6Xly1rGWXHBZ/ut/sqeh+tctNq32DVHtmLhHX
    p6c/1rorprY2KyOqxuF+4vAH0ryyaSZdbvHgn+b+Bn+YZ67fbNa3scUvI7y/jaPfcIsgUrnY3zJ+A6/jXGa
    k5gSUzosc9x837tyMKO3pzXTafqIk0mM3amOQZAXqEUDJAPrn1rl9dcLbPcTwlWf5wq87h2PsBQl1MX7/AL
    qMe6i/tKG3Dys9y2IhzgH0+gqKyvZ7TzCFaG4RthhUcEg9zWdPcSySlkdvMhXeWUYG7/Par6vDtWOVpC4+d
    nPA3Dk5qZpS0Kpcu7Wgmr6lJdRypGCsszBp5+hVQOV4681R0+G+t7j7U4ysWZMt0UY4LD+QrQ06GTUm+0XC
    p5RXccEDgfdDUkdwNRnS1tsYVt0krkbZMdvTirSvYylPlTl1exW0hZbu6OoSCR5EOEZY/mZcc4FdLFbRT6a
    yS3MUIJ2yGbGYx1JPv6CsU64yLJ5UeMuQfK4AHQAEdOlaWlSyM08RESQXOAxlTeyk9xnjPvVOz2FTlJLQ6W
    2e306SWCynfUrj7Ouz5QGwc87sYC9PeuZ8SnUrS5jtLm0ea7mG5Vz+7CHqw9TXX6fftpNhcW1u0808owsSo
    NzEf3nPIX6Vzc1tqFtE88ga4vpgZTzkIccAHrgDtS1RcVze70KMV1cancJZW9r9mWOMpH84Cq+OT9duetbW
    g6PbJDbfand5ZyYpVSVU8sdju9MdeK4bSYbxLtmsyWeXJIbkAHrXd6HBPpjSXEn2a4dlCnzTlB7/AIelLmv
    uaxoXjdb/AKHaaLoWmw72e1QwwIoZEIzK46t5jckHjmrtzI9yxubhVt7CMZCM/Ye57fTrWTc39rcajbOs89
    2JYledIyFxjjaoHbjvXQ3c1lc2CLeW8KSABVSBSyxr1xz1IFK5Dp8qujBvdDja3a+spUv4y2YorfKrk9N+e
    2eg/Gsi9Rm1G2tbiOKKC0GWwT85I6n29MV1Vvqo1WNnjgnGl2YKwRRhYxI3TJz+XFYovGOqXcmoJukCBUXG
    ViAGRj3FCuVTjbRbnQaPNbo3mghFKHai8Kop2o6pC81vEsqiCNgxK5Lsem1R/U15vJqt2upPbpMZN5y2FwA
    Ce9aPhSaW5uncFdqysAFOeQaLo1UNrnaao8k0SwRrHAbhwwYZJI9Pwq693BFawWsQd77zNhkLZwo64Hp9Ko
    X8ziMh9mY16qMbfrWNCXZlk85m8seUjD+Jj1A/xqblqCaVzbmmuL0PZ2YG6SbfJOedoU8AD8Kt3Iu0hljCE
    Sn77uenHU9yfYVJ4Z082dviZgkzP0PXHYVf1sJp0E8koGAm/k9Dj1pbiUlF2OV8PWj3RaSVSVQbQrdGbOM/
    /rrslWNIsQ9QPvEfyrN8KKLPS7YTtHJcyqXfHUE8itKMuqFX2jGecVnJDk7vYpW+CkeRw5yS3er8cSxs8xm
    8tY5MEg8YNZf+tFsqtuZVwB0GatGbzZmRdxQL+829MjtWauN7F23BEGVwd2EXPfJyTUtwhS2aeQIqtnAU9T
    261DA2YyQ/7s5J3ccD0rP1uZ7yK1trdiH8zKsB2qtjNK7LlhNC0Uauu985O4Yx2FSRhpIWjzkF+cexqOC3I
    QLvGfvHjnI7VJAfLh+U4K8nPepuU0kxwndog7Lht5HHYVFKwAIwCR0P1qZUDxQpuA5O7HpVSXarNtI27s/T
    HSpJerGTSAI/qw28VVa6fYVX02j6U53+/wAZ9B6UxlyMAY2/KKCkiGSVndRjIHX6VGyE7S2cu3H0qRd6xdM
    u7HLe1NcZfk8KOKTGV5MICIx8zHriprHa94qSDOMlRnGSBwM1AWG1X5ycj8avWlheRNHNbbBuGeXXP5U47i
    k9NWNnvvmIextQxXLblPB9Kyb05clVCIRllUYC+wrfuRrCDIliZjxyy1zt+8jTXKzHMmcSEdCfbFVK5EbHz
    1ayoVXOSfatiyG5T2Xsa5zTZE2gHkmtq0ckbc8VpNGFJmpa5y+ec8CtaGX92qkEkVgxylG4XpWrbsxUAHJ9
    K55HfTlfc2YApkX5cZq7IFDfKeapW6lwo6MBzVhWy2D1FRY6ItFq3n65GMHFTuT58YQZGN2aqWq/vSXPy9f
    rWpE0SXBzjZtGDTin1FOVnoEzOwUkEZpXGIgfWiVxuADALU8EHmMNuXUjGPQ0cupTlpcrC43SKFOc96tKXl
    ikfjbGdqjPr3xWe9q1vIzoCRnkf4VasI0lVH37YgD944yfSqSFJorXlkt3hnAYr3q9pCvbQgcEHgYqUANGQ
    pCknpVi1R0jVdqsB3zWltC1U7mvAEeNGYgH0qNozFfJgHEqFePUVFbMdxBjPsaS8lmWAtGMzxkMo9qaXcwn
    K5bs1AXPYMR9a0BIDFlT16Guc0q7ubqKYxKpeNmLIwKkCq1j4ktY5Lq2uJCjg4TfyPzFNWRHs3NN9jee8WO
    aSKPJz8wHqe9aULeYy/cGawdPvLGSfcZVz2yea11uYcKsRLe6g1RM4qOiL0iJCSZRkfwsehrm/EEf2xDFDl
    iw6Y6VtXG+eMoX2YHy7+/0rBj1Q+cljOu14/k83HI570m7IdBO90U9D0VLWWV2Qr5g5A9fX3rq7WxEduiJk
    IvXnkimafFuJRm3e471rxwqsBIGNp796uO1jOvUcpXObuS9vbzhWbKzMa5A+IrgajcEoBHFhXXu2emK7l5I
    po5BMxjzKw3Y4H1ry3xF/o2q3E20PvXiMnG4dN1J2vcqk7qx2+j3TRark4DSxcKVzit2+
    +ziERtJGwIxhece5rgbC8e7itprGZo22eU+49G7it/w5qU9vqU0GqruYovlsoBB9cmtdNjKUHfmRV1VHi0q
    5htI5HMrhIw/A3N6Z9s1ClhdSXMbgW9tCpCsvLEEcbhWrd3Vpcaj57HMNvlYgnPmSHq3+6OmTWDrd1dMoa1
    lwucgR8b/AFAJ7VKfQlN6mprNlNDbN5d35oP3wygc+1eOatbk3ktxbOQqTAGPf1k9vavTICLvTjbm6aSWcf
    unc4VV759x096wdY0qGx0ORigNwQIoUBwfX/65NVfUxk7LUxvC99MusyWFwo8mR98nmNkbuuzP6n1rd8XRi
    BopYFXYx/eR5yPqP8K42O6W2ggumk3eYyTbh08xTgg/UV2viGCOazluZTjyotwHpnp/Oru27GUUoxb6nlys
    ZJYxBOWEpJMjcKcH+nFWYY472eW1aaXy93zMTkyNnoB7n9BUEVoYNVFpFA8x8wKE6nnk4PYZxmrNv9j/ALT
    SON0/tDzGaVyMxxjoMDvVWuzLncVyrqaGqBp3FhZ3LyWy4MzhQmcckA/yrU0lbD+y5IEs53uYV2lNmdyt29
    CelVotEinnjVriRpbolm3Nj5F5JP1rWsNHSNFm8qZ7eAhxG7EB3Pf1wBRdJFxg3K5kpJLaWtxHPAZZ0wjHy
    +YgTnHPGT0zT9Rl+0J9pt4mgj2qzM7ZcYbjC9K3J9Itr21S4g+S7kcO21ye2eh7CuXu57qHV7e3nmEw87KK
    yjOBzg+2e1TpfY2akla51FnAba3g33D7Lo5kDNmUj39B7Uut3cT2EiWakQy/IGR9pZfp1AJqHSbH7Xq6yao
    lyLc/v5gMAFV68DoPatmeOz1CaFtNtFjhclkjWEgKo+7n1JPammtweq5ChoumhmewujFZebwGiHzYA7k+tb
    d/pulpZLHbl3uQm3ZLnJI6kGqmsTTyl0a3PmqoIk2YII559OlPi1Fr6S3eZF2w25dmAwOepJ9eKxcrux3wp
    8iTWpkaFcyPfzblXECCNgBjJyTXYHVIZBm8DpahcIgHMhPb6VleH9IdYpHmZY1lcygdS3tWzZ20Laqs14iv
    FHjZERkZPehKzFUqJpI0NNYDzLohlVDhEK/LED/U1jXMaf6a0TuZZ5Mgv91QO9XNZ1KSyfy7YLFHM4DSMOE
    4z09a5qG/VtLuJjN5pJcKy8BwBgH8a00scrvKWmxhC7+xaTfXzoWmllYI7c7sdPwrX+H8T2VnFu2mWQljt7
    FuTUGlWC37WtlcqzNbbXkjPCgE5wT2rpJGXVYLtNMlhhsLQbZJSfuseoU8bj06VPLZ7lqd1obMyJMIbe13T
    NKQ+1uF+p7mug03Q4LURSzKnmDhFHSP6CsDQbu2triKxtj5jLbqrOTk5PfPrXSR3aRygGL5gOWY81MmLlna
    7JZ7horgeUFZ8fgfWuS8Z6va3N/YacwZI5nzOFO47AQePx4rW1K7RMyE4PX6CuTuoEmjOqTx/v52xGCcFYw
    cD8zk1nzM3hBO3MdFHLb/AGwvp75jPHXOD6GtpbgRqu9s5PzZ9K57
    TLUpbEQZAXq3uetan2SNIN84aUY4ZySB9BSTe5c5ReiZHYP9pRZEUhBIyKw7gHtWmGSKBhAuN6su0dS3QD8
    6xLXURGVjWESMrMRH0wc9/apvtU0MKXcgxKW2x4P32PoPQetN6GdmbUciQxBJcfuwAxP8J9PfNRLD5d3Fvy
    rSLuxj7ozxTNNheNJp7rDTAB0XsD04Hr70sDE3zvNJu/dhsnopB6Colqrk21NNlInG7Kv5RAGOeT1qvOoIb
    c3IIHHpSTzs+HLctgZ74qFn3HcvQtk+tK6Js+o24Mi3IYYBHAFQqpzM8hGc5xUkxJ2KoLMf4vQ1Vjhk8sDJ
    Lu2WOegqWWloKq7PM2nLgA5PrRGNq4B+cAA59aRg6glshSegpuxlQkktk+tAxkj/ADtu5GRimFBySenpT2k
    w8itgMAMAdqrSzeWm7LNIAenTNINSN3IkUbcAZIBqmXAZpHZgy5wAad5kkrPK67TjAX+tXILtgLe1Wxtp5X
    HXBz1700N6dDCvpXk2k5KggYzipZ5BGWDcKq9u9dDLFdtOFXRLYjd1PbH41gasxS8mDRpGzSEFR91fpTasS
    pX2PmnS59ygkDNb1nuAAzyTXIaPIdq59a6zT3Iwx5U10VEcFKRrRqTJ3rRgcRMCTn3rOLtuDDkVbjUyKTwM
    c81zySO6MrG3BdBlQx9ScGtBSpk5PGOa52xYFSR1zmtq0nEsYLDkcGsnodMNzTQiBF755+lSrMJiDgcGqiS
    Ertxu9Pal3YIK4ABpGnqa9snmAswBqwjOkh2OAarW0hRflH+FTSusatjPzD8qsUn0HXDEHJPTmormVbeQNF
    GZNwBZR0+p9KgMkkX7xzlV5HoK0LdMglmV2Y7mI6EHtVxtuZS03IZmd4vNWXHHyiPoBUMd1cRKpLrIO46Go
    pYDFc+UjsqNlkHYH0qK5eKyO6ZwpPQdzTlrqWnZam5ZanHu2vmFj/z06Vau5GA3LgjHUGuZe+SRWRG2kDoe
    /wBc9KklaWW32WxyFGSY27+9Ursy57SLF47n99HG5mKlPLViu4f3j/hXNyQi8v1eNjywL4+7x2q/eahcSlL
    aZfKdBndGeW/Gn6deWayEQzxphfnjI+Yt61NSVkrHoUPdW2512lRRJ+9jjVAeMYra3rIAvyhj0IHSuT0fUT
    LGUG1wrcyKeOe2PWt2xuk2sxGVAyfXFW2c1eFnc1rsOlvGy4eZm2x/X1qFbaIOn2qFXfPMmMMT6n1ptnchn
    MsnUjEa+i/40XF9AspWWTylI4LetNK5yxcolq2jESs6S4K9BjgirMl2JoQ6EBu61SVlWAAZUOp4bgn6ViNe
    vpt2Wz5kTggxZ5z61aVmS7yLcmLtZV/5ZLIxcnua4XxbaJeWkF0WKTgNHGq9AOoP512k88cNiIxE8m7532P
    zgnofTNczq8ltJpEoO5ZPtkaFgMjaxBGPQUuRXIjJxdznLQC0Fle2waSSN1Z4scNj1ravdalvV82GFoLh2M
    jSgZ+XoVA9aUSQJlthaO3dxsHU89fp0rZ0+xg/s+OfcBMDujJHDA9MCrs7F+0XNqULGzkinWa4lV43TKgrg
    gdRjH8jVDWvE8Fhqgt7pI33ACNsYBJ6Zx0rs9Gt5IZmim5AG9SRyFNcl8SNAtZLOeQEfa1HmfJ27j8e9OKs
    jKc1eyE08/vbi3eI+XMPMWR+B9APQGsr4jB7U2dszecZEG8oedhGMe2fWrVhKBZ201zcBZIZUjm3DkowyCP
    r0qT7FJM11fXSky3Cfuwy42rnCgfhVxXVmc3FuyPO9ditW0pRaMR5QXbF/cANb3iS8uNTttKgt3WU3aGd2A
    2bVXA+btWHr4aC3nQKdrNkFVwQQcVN4du4bmLVI7icSaf5akrjaXC8hR6DP50R01M6jvLlMma7lh1O4ET77
    qVWjjdeQi/xHHvjrVvTdIS3tFuAyxTuu+Zi2Sig9PqfTtUUFuos31AxurO+1GbhiuOQB2FaGmvLdwKqqfIj
    TcwIwCc/rV2urmSVpam9EEmjgkubfy7JfljhXKsoHbd1Oetd3q8lrFpCqWUSSIWYDoiEZCD3x3rifEBZktP
    IkwoJIC8bRtOaS2vY9Q0426uWdANxzxjoAfpUtG0F7+u6Dw7qz3C+TDACkWVDt8o56Z/Cs8GU6zbX8sW6Uz
    BBhQdqDjPHbrzVRXW11gwW8qvHMCo2tkhgcDA/OrNxFLDqU0XmCFVURuVfpx93Pcn2oKbTZ0zyvPqhisWSD
    SwGXn5gx43At/d6V1enMywQXBjCQJ+7hAYr0/jIx37Vz+jyQRyeQdqQxQgIpIbCE85x3Nad7flo/KiLtEuC
    MZxH7571m5djRQbV2M1m6e4uFeEMp2kSMw4PHXNUNMtf9EtVt4TLHlZJyxwGAPyp+fJFZ93fS3sc0MMjC3J
    /f3BUgADnj69q1LTUFs9Mt5o4isMXzoXY+Y2T3oStqxuUm+WL0Osi0uVbtGdQh8rdsHPU9T6fSo0VbG4aVg
    T5nAfryvTFX4fF0dzLC7RJuaAoWbjp7VUvb62jgt7i5UtHDhlhXqeOaGSuZaM5zxXdI1tECNqIHkbPTOCBz
    XDaaftEAtFjdo/3YZVGCzHkL9M1a8RXdxr99IiReRb5IMYyW2jnGPet3wxootI1vTCVcqu0yScse7H3wKcV
    b3mJ1HJqnDY1Ljw9utoYLiTEL/vJY4m+eRx/fb0HpXPz2NzaxTx28sYijPyqx4GBkmunmaOeWN5L6CFE5dG
    JUgE4znvVm7s9LtPD6yyvmWb5Y4Ryzvn77+gx0FQ3dndTbpK0Ve5leDFJvYnlXChV3HoSOtdxKHeR5YoFig
    LbAZX5J9q5nTNQS8kmmFr86y7ECjCjAxjHerd6ZksvNmdfJif942cjn+Ef7VCVyarehH4gE7zi1dwNxCkxA
    ZC5ycntxSfY4rq9VLdCsMIAiXJIPuSevHb3rDs72W51Ah5kEaAnZjlfqfTFbL6vLZwtO2FlX5kBHAJ/
    +tU6bEOMkrs3r+7S2uIdOCLHKAXkCDqMd/xqjJqUsi+RCDKwGCDyEz3+tZdkszyG+1AMgm+6M/OwH8vWtTT
    4jeK0dmvlxlS0kzKQOOo96WtxLlitSHTLWV5mRGXdI7bi3fjqTWhFBh1ZgZJSCFkfov8AuipdLVbaKOckMg
    yiM3OfoKsfad80hY5x2IonJBzSbGtIBHsVmaVlO537DHQUxSHwdzEYAOfaouWwoGS3GfSrlqoQSbEVgBgbu
    gNYN66F2tuRHzGkUZ+VWxg/w1ZjX7PGUyM99wpvEMZIO58/rS7nnmbzOe/5UCYjEqD5ZAwuR9TTYmEZ+fOA
    MFvX6UrsuNq9OgqvJMPOCFsjGSfSgEI8nnMXBJTooPeo5GZkVRxSSEbV25HHAqF5GWNicDjAFIdtdCOM7Jp
    SrB+OSabPKqW64+Zic/LUbSCO3j+X94/zMB2qCaQeQrEEE84oHuRySiQlRuUlsYq3psqw6njeqO6tGrk9Dj
    jmqokURBiBtUE/jUGkW6XupASb/KCtI+B1A5xTiRLVO5s2sd69pBFBJm8tJiJBvz8rd/cdawdelhk1e5it9
    pgViEI/WrMc1p9pnkngZrd22hFflc8DnviqGo2i2V5cwDkRNsDH+dVe6IW58r6XLsYDPWuw0+QGIc+9cLYH
    58k11emSApuz0FdtRdTz6UjpIZ8squ2M9K1IUZsjkR/zrDtQJSrFeB0zXRW0m5MHHArilozug7jo1UEDOD6
    CtSxYrJtwNpNZQGJC3PFWoZNpyGOazZ1RdtDosIOBxxTkHB3DOelU43eTY6tyKuyliA5OSRzjtUmt7l2N0j
    Aw7N7U2Zmzuydp6j0qCAB4HYHntVqAho8OPzpiWjKdyzGParYUkAg960dO1BREsaxEEDDEnPP0qleW5V1wc
    qTmmWjeRdiRT35z0NC0FJJk11M84ZlGxA+CxHzKfUVHBOkX7iQBrlASQeS4PRvoas6hcxjy54MCMuFYHux6
    H6VX1OzEQRiSD952Ayfw9vauhK6M03crXkEqs1yJuPvGIdfzNRCO4+yhly0zYbHCkfiKNRSdbQMsxMbYwfU
    ZqGwMlxeuizkhR8wzjNLVBKK3IbyW4mUtIBlSQWjGMn8aS18i9ubcGEwsibZWAG5h6+lbFzbRvCIxGDcH7x
    J3D8azEs5IJYwJFLjORjAx9arlUtjelUaSVzrbO4t4LaO3t4mhaM+vDD1x61aa98yZlWNsoRkpxXP29+qRl
    RGfPc4Dbs496045i1nlbadjGCSEAO/1JpqPcqtJSLsutm2VzLD+6UZZmYDb9Ky5tet753M0qSfMvl8cAZ64
    qrdwo+mzSSRz4C5ZiMD2riRBNDeq5hEUb52seTt9aaVjnfLy3W57Il+t3EFacSMMDAI/DFYupSG3S4uZZAw
    GVSN/vZ9R7e9ZOm30VvY7Vsg24cMp5f6Z6GsvUjdxtcyOkkDiEDZNxlM9BWiMtkXrTUmsrR7UyqsrDd5ztu
    LjH3Qf0rBttVuJZ7aCWRY43cu2RgFV6E/SqWoX0c1uyyQFWRcI+3aPqDWBPcvLYO0mUGdpKk4PoPoamzcro
    U6sFHlitTrrC/lke6KgtbkeXI5GMnPBHrXe6JeJZ2jTjdJIke3c38IB7DsK830FGFmiFsSDbGi4yv1+tdtF
    ZW9nIzh2GyLMwY8EH2pxbexnJJLU6jTtagvNNE0Ii+1RybWwc7lPGT6AVznjeX/iWXotAWfyypYjOSaqeG4
    0S6nVv3dpOW2P/eFO8TSQ/wBmyWwlZYyP3rDg7VI5/HpVakS5Yq5x1lrLyanpEE8chSQqJAoH3QeR+ddb4n
    1yVbt7qGLdEI2VBgja3TGPauGEMk0pCco4dInHGMcjmpftt0pht55XNtuAde6n6/rVXtqZQipXZT8T6lFfW
    kMSrKtt5oDFuGOOv61y+qgNqKQqPJtmKyuoPAX/ABrqtRskGtBdORmUAySXEgyXYjoB645xWPaYnRtsIGnR
    sSwIy7OP4ifX2rS10cz96Wg67eZoA1vCBEina/t7fhXQ6exXRWjHzea52rjnHHU1mXqywaLpkvzCOSMlsjs
    Scn8hWv4WtpU06G5V4pZbkF4lRgzBQeQR2NJK5afLZkCSN9utYjOBDJuKk/eQ45FZCMlve3NqWaXbkoFOF+
    pxTtaYpqx3vt8tx8p6ue+KsWdta35nMGLZYACoVhgSHtzV8pLm3K4WRSTULTzUhChmy0a4eRQvAA7Cuqj08
    TQ3M9pBGLhgqgn7sYxzkHqfesDTrV7VUfzbdZ3jfb8449SfSvQdEEbeHre2t7WOe7mwWO8tuJ5JwKzcbaM2
    jNXv2MWJrlJrfzZoYDgLtEeFZOmQe9dC00Qnt1SRpUzxKOETtkj+I1Q8WWczaezn935TZKonKjpx7UsV3ei
    wghEytCyhUUxjgetY35Xc9FR9srJWNLXLdRbYUGIqpY+Wcqx/vN7+1YwR7rTxFOwflVQng7Rgnitw3VvFau
    NTmAV1wqkZJOeR+VZdnNGqySM8aSEAIfvGOMA9R2OOtU9VcwvGm+UdoV/Hc3Mst2GS2tQUB4xknv70zVtTm
    1fZZ2xm8mEB5go2sFH8TN2HYDqTWNokE83kvIG8qed2j4z5o7Mqj09TW9a6XMbu5sxIIrFv9JmaQ7C+3qzN
    1PsKLGcm5uy2Mm92WcENoiCF5osDLZMcbMATjruNdbp0LQafHEqKgjJC+bycHoQv09awbkwW00Hl2wEt/Os
    mwncVjQZAJPr1/Gugvnkhuow5Ae5j3qCfuY9fbFKe2hdONncyGsIr27nVh52MFmf19BTjBb2rwtKTsUFlJP
    tzWho8MqwloMBCWZpGHbpurJ1C5je78uH94U6Mwz7nb+lYdTpVZ2sjRsr77DD5JhciQl40/uk8b2q1qkjJo
    bibZMUUpAij5UY8Z929zWLpFqPLuZb6aTylbMgLHdIeoH0q9eXP2ieKO0jItrdlZ5XOAT2+tbN6GL1d2MtL
    AWcQiZoYZBtR5XPC8ZJxU8FstzKJ0f7RHEfkeQFVJ7sfpUNqEvbySW5YvHn92u0MXbPL+yj361rLE90sQbb
    bWSHKxty03ucdBWViudyLFjbm9neWZvMjjXYpCbRjvj/Gl1C7Yp9gssbT8hIPyKT/ADqwYpZVeTeUhJ78DH
    oFHQVUuHijZUgjxk8t60nKwoq7LSRixhWFpA77cEds+3tVhApLsQCQBxVRLZ2OQAfc1dgjBUqOWbJNZttmg
    kcZL7wuAenpmr0alYgSRhfmOO5quu/YVPGF+UUrXMaRg7wzkAbfSpDdj9pQgs2Ruy2e1Hmxglw2O/1FUZ55
    JHyxAXHIFNb97ywYIvAzxmgOXzJ3OT079aqTzRo4U4DY60S3ATauTk8cVWlZZC5I+bO0EUDih0U3nSnJOwU
    2dkZyyA9cDPekhDYRThUJ54/SomljMpEfKJyTSH1G7do82VuvyjnoKhv7hZHKwIdpYAE08EPMgYZRRnnoKq
    an5bRjJIAbII9aYD5yrRqnqcYqext763mhmtV5f5ogSMFRwaz5WWNV7kD8jV7S7f7Vdw20zSCNUJbZjgYz3
    pxM5tJGm6XayF4NEtRNu+V/M4z64rm9Zea2S4+1nNxuww65Y8mtm1j0ibUCourwBHwGZRtLHpWZr1lC3nTW
    s8jPbzBbmOYAFM9CMdq0MU9T5ChYq4Oa6rRxvG0EHjOelckvWt/w9JuuAhPOOD716Elc8xOx2duHEayHhM4
    61r2rjIKnI71lC1ka0W4H3D1+tXLB2DgZ4rhrRszvoTujYTgZwTntUihjwByenFNg5IPQ96twFSxA4I6Vgd
    q3JrN9j4OQPerssxIG0MfYd6oqmGJJJb1qePlQXAwD1qWaxLlrKcgCJlX/AGqtGdlU/J+ZrMEh3DJwAatpI
    CSHxii5VkT3lwzQwKmA5fGW6CnQKSrLJGpGPvKenvTZI1YhlG4AdKnt5GUhkwGxt5HQUX1FbRlLUkb7NHIX
    jKMRuD8EEdCD2o0fU5THJBqQ2vu/dSk/Iy+laNzBG9ou5/4wufSsy9hEWY2UFZeMEZjf/wCJNdUGrHO7pkO
    o74IpwjeZby/dUfwN7VTnmt/Jt3icCQfLwcMD7ikl+02UTvJCLm3JGInOCVz2Pc1TnWyE8rTsIhgeQRwB/s
    n3+tDiEqqvZlv+2HtyFkxIeMmMHrXQWTx3sbTELvUZMbMAce3rXPzKyWe4xebFIOHj5zx0IqOO8ghtVm8x9
    wXCxp1HHr/SlBW3Kba+E1pciZ5jGqIeVJb7oFXLfU3iV5QyzQqNxCthh/jXmNz4imaSZYZH8rOAj9VJ7+1S
    abazzXCRTXRWIkF9mSuPc981qQ8RzPljudZf+JYbq8DNMfsQYIsL5ILf3to649Kz9Zv4bp0UQXYMbfvXIKu
    QOgCnoK6pNCsjDEtskc8g+dNnVfUcdKzPE9v5KrbRSm6uZ3VUPR8HqCfb3os+hE3y3RmaVLqGpQsluksZBA
    i3twjDvjFQ39/fvaSCW8824icrdELnAzjr6/Sn3Wo2+kTC0WeeCViIhGoDsCeGYnvgelZ8yf2XrIj0m/j1B
    QwOTEVVM92z0b61cW0tTDfSJd0u0k1aFVmuwLKP5RGwCsyj19K07zRLewVGmdZA481kJ3jHQDjuBWXNLPdX
    EcFsY5Jd/mSxRL/rD7mt6x1izZriWVLiSYKqSGNdqj16dDV8ysZqDRX8KxxW+qTRbjJaqA8Y2kuSeMgVJqN
    /NqOqNbWoNvZpw8yjkY/hP86yxrErRTRafJFaCQ+WRGT5oGcYyOnHPrVrW761tbWKG2eK48tQwKfKMD1J96
    huxcU5as313WsavDcRSIql+ByFxjAH1rGa2bXIlmeXznu22vCp2+UqHofUnrXOr4nvZpVXCeehx5gGFKf3R
    VqDU1is0liS5hcO3MQ+QFjgkn0xTST2M6m1jb8RuLfWYbTSo9xt0Ztq/wAAIAGf1rMvbmJbB4bVUESYWW9I
    wA2cnr1PNW18kWM97dTiG3vGypHzzsqjCqOwHeuV1rVftyrZwFYrGOUYth908c7j61cVbUhyaLoGzRpf3gS
    KMFmYZPU+vqR3rJF0bPSZ7a8hkjuJQJY9o4GfX3xiusjtLY6ckQfFrKMEH/lmoGSff0/GuU1ASalN51yH8x
    JAvLYBHGF/AAU1qyZJQ0LGni8fTAUSSdUIjAf7qZ9KkjuGj1Bg1xJb2xJVtnABHQD61o6ZcxW2nsttH80lw
    GEe7LcDk/T3rP1CFZEAMymZp2YL1UY5P/66bXYUWuW5LeQTfZI765UR72IhGMlUXufqe9Q6XaNNNLIQGkdg
    SrLwf9o1YspW8Q38McbP9ktl25Y5Bx3x6e1X54XkurgRAxxSBQZM/fA7+3Ss5Ssa048zu9hml2S3Wrwx7Fi
    ifmQkDJTuR+Ver6GEWyRoDsESlY8HGfc15JpF6x1gX81sJbZJdgRZNnbBI9RXqOnyrb6QJbi4traLaZGwC5
    XJpVJPc0pRW5U1dJJSyPMAXyWY8AKOtLYwajOtv5P2dgqZ3uCA3HAUDkmoZVLXtrMY2aK4JWES/MzcZBI7Z
    64rWtdTh0tXjSPfMfl81uTjpwO9Z2W5vKpJo5zXNFvdSmnMl3GsNsFHldTuz0LDvWVoFjd3VvbWzqNkk7Fd
    v/LRQ3JPtW14n1KW+01105ZEtATEu0bfMdjirnh6yj06zMl4GM7KsccCHqB29TzRuTsrdSS6v57O/ltbGOH
    fLBsluCvyRY/l+FY/mXWuW0aSzB7WFt8rA/O6j+97Gr2stLBcG3Z0hlPzYztOT2/CuQk1R9PubljcQqksh3
    eWcDCj09DQ3Y1pwTJY9SjbxkjXLTSW1suFHQsc8Cuv1O7D3AllYuEfLkdMEdPoK4DwjYS6ncXl6wJ3TKViG
    c4+vpXc3JXC27KFV2CmLp8vfmlZpWNLqS5jYadbfSY43ILADtwc9h61gW7TXEwPlorStiNT96NM8t+PFWru
    Vks3mct9oBEYCjAjzxke+KW0TyIGkD5VYuT3J7fpzRGKZg29kT3LxRu0CEOVJ4HJY/xGqkzTHSZpGYBARk+
    jHsB3xUdsYbi4RIpNq48x26sy9T+dbEVtHdXFvC0Q8tQZCOyDoFx3yTnNTy21YSak7I0dLsLdbOMErEmAWL
    cl/bHp7VfmeMjYBuyw3Sdz7D0FVUmVLMRRgBkOw5qTzA0Q2LtIPas5SKjG428vNkPlsdu04AqO2jEpDsO3H
    pUdzatcyLzkjnkVfgQIMsBgjt0rN66s32VkOPmKVweD2FXIsDgD2qCI/MuVzjnHpUvnAfNkdCaL6GbHyq+C
    2SSTnFVljUlt2AT0GMYqwJyFVwNxbsPSoZvm5QkuB1NIak0RsVVSxGaY7NKF3NxngU05VeW8w5pssjtlhhQ
    M9e9BQpWNWEvyl+Rj0qGJgZXDjhV/PNRLHIXUsfy71L8yAKADnk//AF6BhKWAI34IGcelU027eeVz19adIx
    bcz8sx/IVBJNmIbeAlIET7htyo4PJHTis+dd80YlOMZYCl84hHeRchRnjv7VUSQs3mvyx6AnoKYrWCNGmvg
    pI8qP8AeMPX2q5Zai9lM07ReZ1DL/eB4wKqq2yJgFIlcklj2HarfhyQT6vDGGUKoZkL9C+3j9aa3MZM0o4L
    SxtEmXTtRJJ83Y4+UHqMt1xXOzanFd210ioTeX0+6aT+EqD0WtSL+3DfM4Nz9oDhTuzt6857Y61m6h9kg1n
    UJLYAQRO20r0LHriqb00M1vqfJAq9pk7wTrInVSDVCpYH2sea9PdnmHfabdtchy7MoPzcdM1r2UhZlLnOOK
    5HRLk+UBuAx1966ixnUgHg54+lc1VXOqg9TqoCPkYelWGQbw6g5rOtpVWNATya1VYyAAgKF6VxtHowdxHkI
    ZS3GasJIojAdgFb1qszbyQRkA0rKjECMnYDyD3qGbJ6FqXZuXyvmGOSKsICCCV96qGLy33Qttzzt7GpRqCy
    EK42yj5QD0NIauXAyyZJDADn5Tg1La27Nb+Z9oYMTwr
    DPFUI5AhYyEgEHFadldxPbYJ5C9u1XCHMzOpNRdiZJpfJMeI5RzkdKqyuQvlPCfKk7ZDbR7Usxa3jZlOSQT
    UM0zCKEkfPncfw7VpH3WS7WMrWbmNgscckhjRgxXbkgD1HeotatNN1REkSZY5JkyswYlGI/vA8qa14ElWRm
    lRCrHc+Dyx9OfSllW3ubWOO8sGbyyfLjAG36sepraMjKpG7OAOqSadcS2zXjRmPkORvB49RTX1DUr3Tmm2W
    7JGoDPwG/Cuku/DGnTL5zPBbGQnIDMQvsKWxsdJeSGK7aWSZRsjeINhQPUAYrVOL3OdxqR2ehyFvpYu8MPK
    jUpyS2Mt/tV0Gn4tLdooofMmJCu4QlQPXOOtaP9n/AGKRY7LTvNg3bxI+0Ngnvk/zFX4rW8edodV1CO3Qn/
    VrDuf2/SnbUUJN7FFZ201Wne+WCMc5Dct7ZH8q5/X/ABAtw0SWcMsyYY8ED5j3z1x7mugk0GyF86yDz4Tyr
    3bfMPoo4q0nhi/KzTxwQC0lBVDkK5QDoF+vrTdlsEm27tnG6YGfzJboi23rh9o3uo7Kp/h9yetbtlpWpvpj
    R/Z0s9KPzF2AWWX3PfPvWimmy2DBjaNcRldsplXLJ7j05rYe6h/dRbXVdw3jfvLAc7R+VJlQjbVGJoOkzoW
    kg/0Z3/jP3gOnX0xWo9sq27R2soF47FSVAVFHuT1H0qzdXDxEFbZ5buTnHUJnoMVoRXSyRqiWywiPg+avO7
    vxSsug3GSOH1uwlkjZ4pETYhQRQDng9Se+eeawvDmr29lqyx3tnHKD92Jjx9Sa7PXY8XnmGcb8ELhdqgdwB
    Xmmt6dLuWbcBhiM9MD/APVS3JqJ21NHxTLb3s5msYzah2GIx39fwp+kahqsUj6VpxhkaVfLQHkKCOTn1rmj
    LcSzugYN5fEeTyo6ZrpPD2kSmOS4hYyAg7ir/OcDqtaQjyo5HPmsi9G1vZXy2skjXELR+WjH/lm/QgZ6Csn
    VNO2zxx2jIYIySzZ/1j98+wHGaytQlkgtsbpTM2QzMOAp7D3qzpcj+QnnSebCVYKM88DofYU3uNPqza0+
    +NzerYhR9kA3ycHIHpVHxS0UerwxW80gi6lVPJb+nFYUV/Jb3G63l2husmMnNW7Z476YP8pFvE0khJ5Z+4/
    lVJ2E3c1vDMAkvSrZMUjYKE4DY5wCO3vV6aYzzXEFvEI55SxWTGVVB/dHb6msmxnFtEzy3GxUQnb2GecCt3
    T1KWInMIhuJwDEhzll9T+PQU3orhF87sjqvCqRaJp1vAtjILm4BjByow3Zi3YetS69pN1bWT6hJGkE0khhW
    Fm3LGFHX37mueg16OKP+zdQE2c/vHGSSCfStG02XNzIHvpFs4siJpj8xJ6J9ax5luzs5OVLuY2neWssrlnk
    2oEQKuOCTk49T1r0PQgZdOUTpCttbna5buw6sfUDgYrjg1pbwyRWUkktyv39idHJ6e9bmiyPClxF5nzhtwi
    b7q56sfU57VDu9UaqNrRRpavdvLqunyZKjcdpQYYLjqPTI7mtGKxj3E28LEIu4yE7iq1g2bSz6jPGhLiNBv
    kbqWY8j8B2rQ1jU5FjFjp5Hlt8jyDhpD3A9h61mnzaDbVP32WbaP8AtW6tdgEdtZsWdzyoPrjuf5VuwWZud
    U89CNwi2opPzAZ6/WqnhrS/J0tAqs21QzBuijt+Hr6mmX9yY94hOZXJVpOh/wDrU3KxnFX1Of8AEkE4jupZ
    yzqTxIwyxHpn0ribzT828skcSlQAcHoGP866vUM6hdw2qzOIt26QLyce/pU0yQTavZwxw5tkBmZQem37vHp
    mhu2pqp9OhW02xm0SytUiXbIxBBPbPXNWtKX7ZNcXM2CkTYUnq59vSrOoMT513cxkgKViTPQnufesVNRht9
    LkCh/NZysS+5oUmNu61JdUvSl7HAGkdGcbo1/v9/yHeo9avfOhitIFKhCflU4Z/djWdJMUeKTIa6DkAueAP
    4ialgtvtl2xEmfmG2WQgLg/eOBVt8pjG8lzPqdH4egd7kSyLm3jABYcZHcitqyaPEt1AWLTufLVuoQcAf1r
    OitZBEILEn7MuF3twHIH51rwAWtqFKb5GAy+P5egrCc2zWEdAgRsDd8xJ5z2NX0hzyPlx2qCyhOfmNXCrsw
    wQqjgisTa1tBQFjVyT82OKlt1JjXd6VTndV+XdnJA5q+skcGeckjoO1AmhpYqNqk89xUEiOG+ZBj0z0qWWV
    hwq5GOT/SgQlnCk8MPyoFewiv1wu1QMCmITtLYIGakdVRlSJvbcaic7VO6TOOg7CnYExj7QysTgk9KPnnkB
    cKCnSmGVJrg/wBwcbqV2xtAPy9c0guJKNxbJPHyiqYaUs/zEKo6+vtU0krYC9s7gTVKe4ZBtyNucsaBoV2L
    KzEEn+VQ74wHBDYXjHvUJuSy4BAU849fSguEOOrLy/1pBcgvG3YUcBscCokIllGDgZ2ge3eo3mzKZOM54Pa
    iKNcGTdychcdvU0yZMku7kCNjuz6VFEvk2rO5O9+eOoqtI4mnCIuVjxnFbAu9ISONbm3unljXLMkuFJ+lXE
    zbIm1C/upbexN5P9nXHmgOecnpUet28cGrS2cbDy45CAPRR6061u9BX99HZX4d3zkz8cVmazfJc397dx5Bm
    kJQE8496p7Eapny3RRRXoHmGppcu0kY7V1OlTAqAeAT1riLeUxsM9DXRWNyEZCuWB6is6iNab1O7sp1Zyv3
    lHINblsfNVcMRjvXJ2cjhEkAwjcDmt2wudgBFcU0elRndWNd0MajBJ5pbeTdJtI606GYTRgkDNNwFdm446V
    m0bqVizMrLIFY/L61UEWJCWOUJq1JIWUFuMioAuSBnjPSoKT0I7h/Iibk+XxknsKbMYrfH2aRSBmTzSeGX6
    VfuLcyWcm3HIxg1iSQSSWsckUQZIz8q4+YY6itYPlRjUV2alrfySwxpcMu5+uD29aat+0t6VDgKo2r8uc+9
    VYrpJFcpFsRAQQCMk+lLPKpv45LWIQqY8AFwfrWyldeZMpLRdC/cXbJCEU+XKoPOMj8frV7w/qTXETpK0cc
    fGXz83vxWdbNJOzPGGaZzjDHhgO9N+zzyzRedKYVVirKuFPPQ/SqtZak8/Mi5qyLHOsyhnX7odzyB6/Sq0F
    wjq0c7hHxujkDYyB/npWlcaXC1qHu2klX7rBnPP0rnm0w29+Wto2ijx+7ZxgbqFHqayqrl5bGgYxLGyyTFl
    ZtzsiEs57cjoB6VasvttvEN8UUuw4KynGD6sTz0qhppmFxM1xdO0yvg7j147dsVo3ax311ttpXAKg8nILD1
    rVWZyuNtTPLzQayl1HEXCDcS53Yyf5V2EsRv7dLuS6SGZvlMKryg/2a4fUbi4lW4tJpY90QGGU9QKo3lzqE
    V1azJKwiwEIPYUnKxoo8yudFqd5d2iI1xcu1sWwzqoBA9c1Vsb6xhvPNtUYmRi3zHIQnvWhqclrcaIx+0qk
    gUls4O4duK4TT717KeS2YngB4nK5BHfiqXkyJcqk2kd5eXEz3IfTirTwqZCRyB+PrWzp2rvewoYkBhmADIR
    82R6964Xw7fGykmijKyW5zIOeSD/ga3LLU7FLxkScLGxV1b7uG7gGhJ7icla7M3xHN9qvZoYomj2cKR3P41
    lXsUN5o4bzHSYj51YDAx1rodVe1nlnk863lTqXZirdOfrXn8Il1OSGOyaZYYwxPH3hnnJqYp31HOacVYzoo
    Vjia9JQJvUBSOoPfP0rrVigldEsgnlBRgxOU3gjkH0xWI0LzLePJbALGSSF6H5eOKdKUfyIkLW7mPcyFcD0
    xkdzW7ehw8urM/VTLECAyPGRtZjyazNPmX7YhIAl2lQpHb/GtDUnk88qGV4WOSj8EEdzVCaJZ7ncjkOpyo6
    ZoRLVh2qTF72S5dVZ2HGwYVfbHrToJ5YAsH2YIzx7nJPX0NQXDfZ4BE4GSfNK4wM+9bFpbLfC7uzOoSOJHk
    mx/EePLA9T+gqoqxEpMq2sCXHlJy/z7nydpPtmuniinRjK7vM2cwo3GwDjn2A6VVhtba6mjtbcyRrEA3mDB
    Jb1J9Ksw3O957XUAYGLbopUG4St0AP8As0SWty6cnHQ1NSVGnFxcPvEShsHlmOPaqySzPpVvAdonuG8wSdo
    1zjK+pNS28SzaGgA2zyAqWX+I5wBVa5cx39pbPkGKQgMMnPtWLirHUpuTTZbispbC4t5WuWj3uHMm7uM8kf
    hXSxF7eLzC0UsZwzFR1IGTk1gGUtf2LXUakwsMlujKTnB+ta+p6g9wt1stmjtVzKQiEKAf4RUcp0e0s2XrW
    5t4LNGluEgNzumfHO1eyj3PSrlrbvPB5twnl+dtQFR80cZ7Z7Z61y+i2bu0DXREjH59rjiP0A+grp7zWBaJ
    b2gdTbFjJuIxvJ45p7ais56s6iDUofsHlWKERwfujk8Y7fXisHVrsBVSIAs6kbicAHuT7YrKa+CJcyJIY4v
    MUlj3GOgFVre43xPd3Jd5Zm/dxEYEYzwMfrUNLdjjF/DEk0O3lu5J59jx2qne0w/jI6nHpWnpjRqzT/vV+0
    qz/MOSo6D2FQ2U32hHtg5VEb9+V/8AQfxpuo3byDy7fG5zsJB5UD0/lScbk8vL1I9ZvVkiaOSRwSQ8gx930
    Fc/ZRS6nLNKxaO2HyeYvGxB2Uf3j61PrV6iObWP5pusx/uk9s9zVrTDPFHFGiBpVG+MY+5n+Jvf0FOyirkv
    mlLlT0LDaZHukhnVI1CgmAHd5ae57sa6PStLhtbZJpUTzZX3kEZ2AD5V9qr6VZBrglssIyHkc9WJrRacvdJ
    G0eBzWUpdzoimy7ZHeJJH5aRiFB7ADFPjlWRY1OB8uMCq9oi+U8iyfNvbj0qbT4lx8xH3jyPSsm7mlkjQiA
    C4AOSOtShV8vlsKKjkGPuHg/d9KjJLRyADIHU+lICNVVpo/lDAEsasPKHIiZcAcmq1urMHbbgfd/KllDhgA
    cL3A9KQm9Sy8m1RGq4Gc81HPIyjOd2Bxioi4VMnczn19KrtMXXC8kcgGgNyYSPjLkuzcYApkhywBHC+tRNK
    0IDqeexxUDOzDJJ3HqfSi4ywbgKjfKMHsKYkw2jecA8n6VX8xMBVBJ7kimu6odmQSOtAmSyyiSLcDgMcD2r
    Oll+YhwAuMfWoZbkGTapJ9QOgpgYyON2MDtQRcsRoSobaAOeD6VUnk2fIxGCdx9TViWcwx/eDkjA9qypJDK
    xwDvY8D2oBNliJA/PGB0pl7djkRDCIOfeoJy0ahA+G6VVuJMGOPIJByaLDkyeGQwxZPyyud5J6AelMihubq
    N5YI5JEB+ZlUkD61SuboSnYvBJ5roLjU7m00DTrrSZ9lpb/ACTpGwDeYW/iHfIrSKMpPsQtp19LYie0sZHh
    C/Ky9G98d65O8ufmwGPAxj+db7319r3iRJdLd4dmHC+YFWCMYznnGPasHxDcQTeINQmtcfZ2mYpjofcVVib
    3Z4DRRRXeeaFaemTlWB7g8VmVLbuUcEdKGroa3O6tLrzAOcfjW9Zy7QM/dNcVYT4CN2zmun06dJPp6elck4
    HXTnbY6nTbkK65BxmtO5CN86HrXO20wi6nnFbOmg3CsFkG9F38mseV7HapdSeGUEjPQetWZFQAYOSOQRVR4
    0dS20gAc4qWzIktyrfeHSs2rGqlcsQFZAyyk4Pb3oUeRKjMCYywyB1B9aI1CSqMZBq3KCd23GVGRTjcmpa2
    hk2Nsk0zOmPKZi+8jKnngH05qlq0MdtO8uxY2PzDp+OK27AtaQ5gMbQ4yUzk571NqUMN5YeZEiC4TLAEd/S
    ujlV7nO27GXDdlLKOVGBWMbTg/MKnud1zZyTxgNlcNKeCQPb1rHKwl3SCLOeGZMhQe4Pp7VWW5NrZtBIpku
    2lMeHYkKp9a1STRnKdjroZ7Z/LeKcMiruKk5DN6e1NF9DrodZ5THEnCoDy59R9Kr4WygtbG1Kosija393jk
    mufiu4LPXZYHJ2Ywg70Xs7Gijpc0bfy1ee1uGJCSlVcqcEY/Sr0KJps5uYZY3jK7Sj5P/fPvVKxvQ6SH5Y2
    dmfA5yey4PtWhbJKWjnu4xJGeYkX+D6j1pLuiuVpWZma1L9qijCosN3I2VLcEDHSor4tNaxi5SQIpw5Vfl4
    9+9O1wLcSK8EgXymwW75PpWpbRONGMUjkxuMgirVmZt8smcXqENxA4ewMgifhjjjH1NVZ5ljiilllZpo12c
    qfu/8A1jXc2V5Y/Y3ttSiUxy8Ry5wVI47Vga15FxJFGkCBU+Vjn72OD+Yp8i6Mh1NbGXFMkyxCMlJVGHPse
    RWno1zLbxpLEqPN5jYU9Dj+VZGl7rT96hCrD3Iz9AfrVX7W1tNKPvYkJZHPC5oSs9SJVLqyPSb1jcaf5YQR
    q4BYkDLKep/pVJNGNsimBzFO/JVfuqueBWRpOpxxwGEpmYndDMzHBH90Cunu2tYtPjv5JZLrdw6bsNnHbFU
    4maqb3OL1K8SHVL+N4QhnCqXQ/LuB9K0DiexmuYUkF2XUN5gwuB29TVSfToHuYvtrKUkG9mQ4wTyBn2qlc3
    s2naiYZHCtGAd/VCD0zVPbUmKbC/iS4TzdXjLscoAv/LM9uK5G42WkjOHLzA4CY7eufWuxurqNrafeskdyy
    /Jk5Vl6kfUdqyLfS21SYruUIq7nnx0HYUJkTSRkWyNqt9slliSLcC0sowEGOp/w71c1WeK3ktEt98NgcmFS
    cPLzzI3oT/Kq2oW0FtKTC7fZYTyh6yN/hVXUBLfItxKVYZ2qydV9iOwq5GK3Oo8IX0VuZnkO1HkwsZPLp9a
    2fFYWWNZoSrKj5RsYyPT2rlNHVZYoomH71UYZA6HtW2kjXVr5VyeJMeax7en41N9bG8bNXNTw1dKWuIrhvL
    mwGYA5APXiqustcPLBKvln9/5m8jbyTgD6VzC3a2dxKI/M4woVurgdefpWo03mafFIxlKtKuB0xg5oa6BF6
    HQ315aL5U8MTtLbybp2ZsL1xgfQ10NhdXF0jvt3eYgaTe4xjsBXH3kTXmnTOQCqplEAxz3JrR0sutkJ1JKn
    aT79Mj+VYuTR1Rhrc3v3sNpPcF447f7u/GW57CqdjBLNMZ3RniBUo0h6gdcD0rS+zJeQhLwhLC1UuzOcbmP
    86dYtLqFoZVQpCI2SNOhb/ab0HtU+ponYzJLtJLqd1LLaRvvPy5JYds1U0PVXuFnWOItlWd5GXo2flBPbir
    9yiQWZjtyFSPJdz69/xrN8K2LC2uDhwZZMEDjJ96mWu+xslslu9zW08mDTZW8wiaSTO5eMk9cfT1rMTVWgn
    lSCDElxiOLucDqSf1zT9YdokjhhDNOrMihTxknpWPFIlrfuoBaZDhyednHQe9PmFNpOxsW0aS6skUcuHjIk
    uZWHGT2rrNBhSeaQQq0g3nk9G/2mPoPSsHTLDdZxW7RqrSkyFVGSe+WPrXbaJb/YIpFjG0uMtj+EelZOQJa
    WJbRPs0DW4kzIpPzkcvnvTPOVJoozGzSnOH7U6XmUz5JK9R6rUxKyTw5HQ5yPSsebU2tZEsSeVE2GyrNlsD
    kU61ZCzmEZYHncOKlESqh2nH9aitlMZcIGJbkVPUHsWZpWPUqD6DikEuE+VuPT1NEUG5f3ny+p7mmsIo3Bb
    7w6D1NBL7EzFoowocHPJprMwUZIZ+p9hUDeYWLe3OaiJ+cZ3BsZ60yL2JPMcg+aQSOmKr3LhMkdemPepGIQ
    Es+SOlVJHCsXZTvHQ+9A13Jwzbfm5449qrCUrkzHCk4AHeonuRKpZ8g98etVrpm44HPHPakCepLNP5hOxsc
    /lWZMzNlFkOzqT3Jp5ZVYjqCKI41B+cALQgchqyxQo43EnHGRTIpCYQWcADpmq1zLHI+Yh8ucVFJME4b7vp
    V8pFye7uCx+Vh759KZbMHkaRgAF4GKoecNrsWxuPA9KoXd4XYIjsqjrjvRyi5i9d3ivIWQHGcAnvVIz5bCf
    eY4yTVGSVscHr0HpUWWAzxzTUSWy+7iInbyR3q/DoOp3tjHdQG0Ns/3Wa5VefQ+/tXPTT7UwOTirWizXpt7
    uzt7RryG5XDRbSQrDo4x0IqkkRKRpDwlqqhtkljkjnF4gzXP6kXsbiW1n2NLE2xtjblz7EdqmvdM1K0jL3F
    hdQoOrNGcViSyZJwRjrmrSM5SPLKKKK7DjCpIXCNkruFRipWKhFVOeOTVIC9p9ywwjHA7V0Om3W1sdPeuOR
    ypBB6VsWdxhVbNYzjc0hI9CsLiNnVjyo65q8jNDN5xxtboBxxXI6bKxYEHnqOa6K3uPOiUE/P3rCSOqEjpL
    e7WRPLK9ec1NEQCTx6VkRoUKsp7etaaTRtAqYxIOp9awlFnZCWli0kio3JqzLcZiLR87lIH5Vl5Ku6jlcd6
    kgfEaoT0PNTqUxvh04eR2QbZPl/EVrXVv50MiRzMgCnlhyPYVk26vEBJbr5gY5ZAeRz1FXVvUvX8vzMbDmQ
    ZwSewrdPUwuuWxi20UtvLKwdkEoDMCMgjp/k1CtkWL/aAC5bdGVbJI9637WLzZGGV2r8uB2AqDXkENqZI2Q
    OoyB/StIySZjOF0Z9zC8ibTIHZum08gCsLV7f/AE63aE5mYYJzzk+tTaFqUP2WWR9/moSAe1XNNtJJpH1C8
    jzztWL0A/ipzS3KhJv3Uauh2StHGsnDRdCPvE+ta4laJXtmO7DbkYjg1lorbYmsJMM3AbqPyq6sksVwjNIj
    xhPLJ29W70oHRUlfRGbc3YKPZTRJ5wDFc/xZ7g1PpM8UViQztuTPyFv0xVTWkkuEklgjURxgBhtwV9x3rCt
    7h7aSG8uUR4A/zsBzjsTWi0OOUnskdFrMMEWjRPu+Vs7g38JJzxXH3WpCMTRgedJIAVJ456Zrc1W7ikWdhC
    ZY3G6MMv8AKuS1aEokDDcky5YjuuO1Xe70MmnZ3NOwnkfzNNRUV2Gd/U575rPsdPMmpTRY3uCRyeuBzT7S4
    iFm73Cqt2eRPv5YemPWnaZOqSCAKGfd5vmjrjuKLqegk3B3NLTYXiASVAZHz5BB+5jr+dadhqkRvzPOoRUO
    Bbj+/wBAfzqbRri1vLCVGHlvI2VDfw/Q1la7ot0sTz23zoDubsW/26u6QpRbZ0VzbWh+yQrIGhlyRu6qe4/
    PpWHfaSVM8Lo0uwFlb/Z9DWVp13cIFMjrxkEv2x3rpJ797uzVo3CSAfLIozz6GoTvuaNLY5WHFsyxScRr/q
    t7ZJ9V/wAKo3NyWRZInZBG/wAqr1znqRW7f6ZLNZS3ERWNMgyQufmQ/wB5T/SuavAtu4EDmR0zlidvHuPSr
    iYVN9SzrJ8wxRzAM8YLhAMmR275/wA4qjGUsruRJ/mjmiw2D0b2qQMkMAuRIzsx4B6qT6D0qHUWUMIp1UeU
    dx45II61oYlqK4eyuxNC3mEgDa3AIx1FXrS9DySxcFpO7cAE+n0rMR0ex+xyFfNdGdJO+B0FQWU7S26kDAR
    ssxHRvSk43Y4Stobt1tMiII187GGfqSenB6Cm2MuzVLN77c8KMWEZbO0jvTrUq9187All9OAf7xpkKk3U0r
    lPKQeWvHJx1ak0VGVmdKS11fSvA4+yupZ9p6jHSrcDu2gWdlaxeZPIxL9jgHqPbHesRLg288SwSf6xSo2fy
    rpPCphitRJLHiVAw3nrnPANZSVtTWM3N2OgFvGdOkuGk8yNIyFPbIHRf6mqtldOumxxJ8jiNVbB6e1V3lI0
    WeF5ckMy4XsOtZFndmB1lLrs8vMjS9Ae2KzSvudKfLY0dXBmgt7ZACkrFnwfugVHpjuFkWNtqyOWUnqT0xV
    aGVZLIeWSZ3zI0meoPT6VUe8UMCA2I1Cqm7BYn0/Grsthe01uLdr5Oo+WMzOG3A57ntU+i28TzSq2GuWlIj
    A5xxyxPt0FWprJkWBI333DsS7AcA45/KrGlxx2UKSRgfOpBJ9R2rCSsbxalY6rw/ZtFvke4YyuwB6HGPSrl
    7uBeTzZHQHbt6AiobWZYbJQmOV6n1NBZTtiL46E59
    K55X6m9kW4YXhxhi8J6oeo+nqParVssS3YjjffFt3Ix7HPQ1WLL5eCxyh6+3rSRr5ssrI2xhgBj0J96keps
    hflIbBz2FKkqLKAAeVzgdAPrWfFqRkRlaMpKpw4Hb3HtUck7PKCHO0AcUgSbNQ3A3HAyPQ1nyXLNchtm3He
    mpIqx5c4z3NRTSqSNgZuPpQwtYka6dffNQrNk5ZsH+dVSW5KkD26mmTb9qhtuB6cGi4rFm4uI9oUvtJOffN
    QtcqwKglu2apT4Jwe3QntTGlCgCMDnqT2pg9CV5Ch+6Se2KrysZGAAChexP61HM8kxAEgQdj61nS3S2yMju
    WPT60WM2zT8xFK9D79qztQ1IIu3d06gVmT6pu3L6DAxWW7lnOTnuatRM3I01vwsjOTxjgCqs15IzcMMnpmq
    jSfLlhgVAcufp0q7Ecxfa7Zk55foMVXLZxk9euKjAx9373pSlSq+nvRYm7FYhDyeaieUlcDqacEwSTimSYG
    DnigLsQZxkc11sr6r/wjGmnw0JjbhG+1C1/1nm7v48c4x0rjy5APGK3dM02Gzsre91HXLjTJLsFoEgUsSoO
    Nz4PTNOKJbJdFXxcdRiMH9pBN48wXGfK29927jGK5bxebYeJNSGmbfsfnNs29Ovb2zmt3X7fWIr61s9Q1O4
    uLW5ZfKnSUlJUJ6j/CsHxLYx6VrOoWKuZEt5TErEYLAVqkZtnk1FFFdBzhQaKKaYBVq0ZehPPaqtKAccUAd
    Hp87KV3ttI7+ldDpt8kU3zsGHIyD1rl7GUXUAjIVHiXqB96rdrICAD1rKcLamsJ3O7sbxZD5T5Axwa1rZ4y
    7RlhuAyDXDwTsqKobnOc1q20zoweQ/Q+tYSOqE+519m5aQxsVbcc8+lI/wDr5MhUyeKx7C6ieV/MZywX5dv
    r9addSTtAZpThc4CjufrWdka899S9bXAURwq+2VsgEc1pzm1hiTau5s4bjBJrnLKQWTJOqq8pbaFP8ArWnu
    7PzUWOMySFcuSc8+wroSVjKMrvUsxOYNQMmSkUi81DrUsco2QjdI/y8j9aWeXzI1bA2bDhTxn2qvdSbLUyK
    qiZ0AB67awkzZJWOT0+UiE2oCbjMdxPXrXVi8nh8tohEy8ZzztA71zV7ZG1ljljk3McMff3NbFkstzG7ogV
    iDlc8OKozhfU07R51uTNFFHIm3JVGxk56ir819IbBliij+Vt4bd055H1rll1GXTjKWiKwZ2kNn5fpV/7ej2
    v2j51jYYEaLnd7mq5b7F8ytqa8im7uo3UYt5ANwH8RB7+1c/qcCNJPHuVVD42D+P2Wrq6ks0QcFoVC87f/r
    1FaOZZI51s3nY5aPewwPc45q0n1MnJPRGXdiXT44y5+UYKrjPJOMVHelXvUmSIeYqYwehHvWvqMFztbbAr3
    MoJaED5QvdvY1nwWCRzH97vdkVVkcfLn+79RV/DsZtcz5WZt3pEV7GWR9meRuGMepx6e1ZUunXFiGKOJEk+
    VZU4+vB56V2k62v2Rn3kXjLkIw4cj+VZ9wsUlkrmUvdBgBhcbR3/ABohczqLsT6RDBHsdWGRgEt95Me1b15
    e24DPHG82Put2PqMVg2Ns10sbTEBiCfMA5PPenre3enh7VUjuYlbdkjDA+lO19S+bSzKGrWiWt4lza7fs8p
    yo6gHupFV4pY4P38OUfAOzdlZDnkYrZjhWcsWjdYJhlTt4DelY01nPbXhRQq3an5ZXb5D9BVx8zGVlsW7i4
    M8qzpFsZBlkPJb2x61l6xpa3EAkWMor8/LyQP8Aa9celaWlXaJK63aMpb5SM9D3Iqtfh49S8nzHNtN8wIPP
    uarqJ92c1qdt5VsZZXImRl2gdHTH3hWRfzykB3YuHH6Vvar+4sWhx5sShgGHUYPGfSsa2hW6VoI3Hmhd6K3
    c47VT1MY6DNPuEiubZpnwquPn7BO/FXWV7W7uULhoid64+6xHIFZrQC38s3G4KrD923Bx3+lXo5o5IYlUFF
    jc7VPOfSqQpa7GirsYIpQyrM7/ADqP5VoxrE7QS7gUJK4b681ytvO5V1TYwAJyTgqB1P1rpdMZWkRr3KZTC
    IOo9yPWjcFoyXg28kcRYPE2Yh6nqa7HSpDGkCgjypYxJn0PcVwmN9zd+SQwCnfj9K6DTriSXTo1XAKKFBY8
    KO9ZTimrGkJuLubUt6vnTAod84BT2Fc/d3AeJkYozMSjRj1HTHoKnurpla3Lx7BGSN/cisIyyrLMkQ/eu/G
    epU+lKStojVSvudrZQufLWYqq+XglOnFVhbqL26B2lQBtJ9evFSWSsLYE7ljEeArHJH1qvpyhtQdZidkIwQ
    D09KlWvYtvQ1tLdj58lzlWZMqF7LUlzepHo0dvAgLCT/WEc59Kq208jKCHDJtAPGOR1pdpnUDkHzF2/XPNZ
    TjI3pTjY7LT28+2xISGRfmX0NMhkL3SMBjHBBpkd3GiMoAUr6dT9aLRZGwe5bniuWaOyMtNTUln8xgIwdiD
    cT2I9KltrgG3ySAGOaq3OI4sISSwxgd6Y0gVAMAADHFQXc0DIpYEMCcdaIVRl5cjJ7Vk+cdnJGfrTUu2RVB
    GFbo2aFETlY255Y0Q7eWx3qo1wd2JhtXGayTcl5GAbAHP1qKe6ZzsQZ96QnI03uR5nykfhTZZUAwzHceSKw
    pJZIjgdT0qB7xwWUj5xTRnKRsTzjyskrjPTvVFr0IWK8Z7GsmW6lwN3GODVN5t7FSxPuOa0UTOUy5d6pJ5j
    bHBb+VZz+dKcyvznjHepI41BLDof4j61LkKQMZA6mnYz5rlYxsvPGBTQETPXP8AOrDMZWOSNg7UIgwGb5vT
    2qkK5WKuU+YcHtRHCytk8LVjG5twztzTZ26jufSgkjTAcnuelRljzuPToKc8mMKvQdqrSPxgHk0DHPJkjA4
    71FI4Bx2pjErURcdT+dAmxzlmyPWt24vLHUNAtUuhNFqVknlRbRlJk3Z59CKwVYYNaWnae09lLdT3EVpYK2
    wzzHgt/dUDlj9KpIzbL+j65Bbwpp+rRvNpwkEsTIfnt3BzlfY9xXPeLbyLUfEmpXNoxeGe4Lo5GMr9O1XJt
    MhvFlXRtSiv7lFLfZ/LaKRgOu0N978K5yI7j3GPbFaJWMr3djz2gHBoorfYzD6UUUUNgFTwCJmHnOyr3wMm
    oRjBz1pKuOgFozLDKxtGcKeMt1rStpy6BlIyOMCslYvl3Odq/rU9lc+RN+6GVJxyMmh6gnY6nTDLKCyR+YR
    6jitVN7kLL8vsRwKzLO1knl82S4S3QDlnJBP4VppNJbIrxzrIM/KWPX8KxlCxSqa3NeBEiTdK2wA4GOpP0q
    203mhSRwOi9h71mzzQTlLhZjJcuP3mR932FW4H2wckFj0rCa+yjrpPTmZW1AupjMZIQH5zUumXHl3IEK5kY
    YB9PqakureY2p3IuCc9abbQM6pEVCMOjCpV0ik/eukbFpcks0V4BleEYD5R/n1ps7IWkjG0cgLgfeNQS3E8
    boJQoMY2ZAHIqNIWS4SeNHIXlh2H0qJLW50cytaxqrpazQN5o+Zhge3pWfp1u8NwbVp4lBJK+Zn7392tm3u
    Y5Q0gkKgHkY5rO1izZ2+0Z24OYzj7rDof6VcLGdSLteJXitp5yst6Fd1lyi9lA9RWiUhjYOD5DPxtUZQn6U
    zTZnntkaY/vlYBxjqaNXOHihRQJmBY56BaalZlSilHUzLqWZRC8qF13bSF+6c9Of6VvW86RWhfOyJMIoTgn
    2qkJYDPDCVJjx8gHTd6mrH2MFypYbP4QO3vWjZMXa5LbFGkn3dZFGf8KfPp0d1aOzIQrddvUfSqtski+cYx
    kKcHPer9heLCjxySNG6nOCKzldF2jJHKT2gt2micFoMZWUn5gD61zGnCWyuZTLM/kiQBWPTGfWvQ9Xi86Mv
    +7CyLhlB5+tcXNavMzQxsyxk79rDhvYValeyRhODt31NjTtR826ubcpHInbnGR6ism4u2F7Kkp37RgMeCR/
    jVe1sns5lMrblU7cg4IqTXFiFoWRZVmUhtxHBFUrqWpnLWBu6HqMF6knmKTx0U8qR3x/WrutaY12kLtOd6g
    7BIfvDriuW0zWYf7M+xvAgSWUHzUXEgB960rNrpJNiTzbt5MLNz07c10XsjnerK+qlo7BDOitJ/DNnAPsfe
    qK3kb+XdIjF4xh1PORWtfBWtmkuC7wyE7kIHytXJRJGt26h38w/KFzx9D+FF7tWQnHlQzW5hD5htwRb3J7j
    p61myQRW7pIWk8leki/eQ9ifatWQLLstoAzLnJDDoe4qpBJDHM6XSubaQhCOm08g/lmrSvqZPQrXm3UrcyS
    sftEWAR/eB6GqaOhaR7gAog2hRwWParE8JtJEMO+RkcrsP3WSkjtYb2ORo3WOWPLmNv4h7GmIgfMjtFiPOQ
    zEevpWla3/z+ddkyIBtCg/eIH9K5+EkSDaSCTxWlaxJdTld5QKMnjoam9yrHTWl1DHpyTRqCtw4jKgcqv8A
    nFdD4Xg8yO5SYFBExTY3865kIttbQ28wXykyNyHqetbugRzJaQz2jo80mQyM2SmP4moqKyHSs3qZeueZE0x
    RnPlNgD/Gq2iyyT6hE7qrSBiGc9AK1r4/aUdC+HlbD5Hp1NZmllbe7uEDbY9+Ebrn3qDR2TO8i8p7BoVLCZ
    m3ZPGVrCsZzDOxc75JWfPOMgHirDzptYlufKzu9BWBclSyNDn5SQufTuahOxctdC4t8beWFn/1Ujtnn36Ct
    2wvQzQopPM5ZueijsK5WMeekKjHlhSUz255NbWlnzIxI8e2HDEMvVhmm1zEqfI7HZCeMMZR9wvk+uK0ra5w
    m8EfKCx/GuWSWFY98ySlGAygONi9s1pRSYtRKqqUcY5OMDtWHsWzoWI5dWbMt2xcAYGBzn09qq3F6ZQsEWR
    LnJYnAArPXUha2twrkBg6lHYZpJ7xLmKKQttupAfM2gY2jpT9koopYht+Rc82EBw7+Yy4JI4qCW7jaEKWbd
    v4x0FZRvtsT2rKCm4yAnqDUUjzCONsfO5O0Z68dalwvsCqWV2a4l2wMVb73O/
    +lKJdsKFTl24/Gs6LYsUpa4XZF1UdzioHkliSORgF/iQdc+9R7OxXtbo05JJFbYCCT19qqT4jDMSd56VAly
    xfeeW2gn05p8+6RWk4yv3fY0cqRn7R2IJss5B5B9+tOEKrtJbgnjFVxK6+YHbovNCq0wxG2FC9TTaBSuXFZ
    ZJFjUZCjn0JpJPlBB5yefaqyzeVGscYy+OSad1Y+ZkP6D1qRk9uM9R8o60yWRGyoGAKe8u0eWzgDHOBWe8g
    CnZ1zyfWnYCw0vzYH3VFQST/ADNxxioXfaAOuars+9tinnqaQXLKOQhZvvHtUMpx8zcGoZJSDgUxtz9TzQK
    46WbOeOgqNQz43cD0pyruPHJqYKoHPJFNIm5Hs+XJzjtXVy5e1hhtIEuJk0lXsYSuQzs5EzKO7jt3rjLq6G
    MZPpirGm6wiWq2Wp273FqjmSBopPLmt2PUo3oe4NaxiZSkaWiWt5aaHdm8tWt/Jkikspnj2S/aN4G1T1bIz
    kdKp+KIoo/FGqLEAq+eSQvQE4LAfjmrD6/Z28i3FkmoXV8gxFPqMwkEB/vIo4z7npXNyTZJLMSxJLMepJ71
    MmVBW1P/2Q==);\">",
    " </div>",
    " <div class=\"lgnd\">",
    " Numerous inflammatory papules and pustules are present on the crown of the
    scalp.",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " Reproduced with permission from: www.visualdx.com. Copyright Logical Images,
    Inc.",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6360=[""].join("\n");
    var outline_f6_13_6360=null;
    var title_f6_13_6361="Peripheral venous access in adults";
    var content_f6_13_6361=[" <noscript>",
    " <div id=\"javascriptDisabled\">",
    " It seems to us that you have your JavaScript turned off on your browser.
    JavaScript is required in order for our site to behave correctly. Please enable
    your JavaScript to continue use our site.",
    " </div>",
    " </noscript>",
    " <div id=\"printHeader\">",
    " <div id=\"printHeaderLogo\">",
    " <img alt=\"UpToDate\" src=\"./../images/UTD2_masthead.myextg\">",
    " <img align=\"right\" alt=\"Wolters Kluwer Health\" height=\"40\"
    src=\"./../images/logoWKH.myextg\" width=\"175\">",
    " <br>",
    " <div id=\"printHeaderText\">",
    " Official reprint from UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " <br>",
    " <a href=\"file://www.uptodate.com\">",
    " www.uptodate.com",
    " </a>",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </br>",
    " </div>",
    " </br>",
    " </img>",
    " </img>",
    " </div>",
    " <div id=\"printHeaderLinks\">",
    " <a class=\"TOPIC\" href=\"#\" id=\"printHeaderPrint\" rel=\"4\" title=\"Click
    here to print\">",
    " Print",
    " </a>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a href=\"#\" id=\"printHeaderBack\" title=\"Back to normal view\">",
    " Back",
    " </a>",
    " </div>",
    " </div>",
    " <!-- TC:TOPIC_PAGE -->",
    " <div id=\"topicContent\">",
    " <div id=\"topicTitle\">",
    " Peripheral venous access in adults",
    " </div>",
    " <div id=\"topicContributors\">",
    " <div>",
    " <a id=\"authors\">",
    " </a>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6361/contributors\">",
    " Author",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6361/contributors\">",
    " Robert L Frank, MD, FACEP",
    " </a>",
    " <br/>",
    " </div>",
    " <div>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6361/contributors\">",
    " Section Editor",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6361/contributors\">",
    " Allan B Wolfson, MD",
    " </a>",
    " <br/>",
    " </div>",
    " <div>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6361/contributors\">",
    " Deputy Editor",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6361/contributors\">",
    " Jonathan Grayzel, MD, FAAEM",
    " </a>",
    " <br/>",
    " </div>",
    " </div>",
    " <div id=\"disclosures\">",
    " <a href=\"UTD.htm?6/13/6361/contributor-disclosure\" target=\"_blank\">",
    " Disclosures",
    " </a>",
    " </div>",
    " <div id=\"reviewProcess\">",
    " <span>",
    " All topics are updated as new evidence becomes available and our",
    " </span>",
    " <a href=\"/home/editorial-policy\" target=\"_blank\">",
    " peer review process",
    " </a>",
    " <span>",
    " is complete.",
    " </span>",
    " </div>",
    " <div id=\"literatureReviewDate\">",
    " <span class=\"emphasis\">",
    " Literature review current through:",
    " </span>",
    " Oct 2013.",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <span class=\"emphasis\">",
    " This topic last updated:",
    " </span>",
    " Feb 25, 2013.",
    " </div>",
    " <div id=\"topicText\">",
    " <p class=\"headingAnchor\" id=\"H27755068\">",
    " <span class=\"h1\">",
    " INTRODUCTION",
    " </span>",
    " &nbsp;&mdash;&nbsp;Peripheral venous cannulation, among the most common
    medical procedures, has revolutionized the practice of medicine. Peripheral
    intravenous (IV) catheters allow for the safe infusion of medications, hydration
    fluids, blood products, and nutritional supplements.",
    " </p>",
    " <p>",
    " This topic will discuss the indications, contraindications, performance, and
    complications of peripheral venous catheter placement. Emergency vascular access in
    children and central venous catheter placement are reviewed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?43/32/44553?
    source=see_link\">",
    " \"Overview of central venous access\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?0/1/29?source=see_link\">",
    " \"Complications of central venous catheters and their prevention\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?30/53/31578?
    source=see_link\">",
    " \"Prevention of intravascular catheter-related infections\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?7/55/8057?
    source=see_link\">",
    " \"Vascular (venous) access for pediatric resuscitation and other pediatric
    emergencies\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2663520\">",
    " <span class=\"h1\">",
    " INDICATIONS, CONTRAINDICATIONS, AND DIFFICULTY",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755075\">",
    " <span class=\"h2\">",
    " Indications for venous access",
    " </span>",
    " &nbsp;&mdash;&nbsp;Most often, intravenous (IV) access is obtained to provide
    therapies that cannot be administered or are less effective if given by alternative
    routes. As examples, IV hydration and nutritional support can be given to a patient
    with severe vomiting or abdominal pain from a surgical condition. Certain
    medications are more effective when given intravenously due to rapid onset or
    increased bioavailability. Some clinical situations, such as cardiac arrest,
    require treatment using IV medications; blood products must be given intravenously.
    In some instances, IV catheters are left in place when medications are given
    intermittently over a longer period (eg, long-term antibiotic therapy) or in case
    of a potential emergency.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755089\">",
    " <span class=\"h2\">",
    " Indications for peripheral versus central venous access",
    " </span>",
    " &nbsp;&mdash;&nbsp;The decision to obtain peripheral rather than central
    venous access depends upon clinical circumstances. In general, peripheral catheters
    are preferred when IV access is required for shorter periods, when direct access to
    the central circulation is unnecessary, and when smaller gauge catheters suffice.
    Peripheral access is generally safer, easier to obtain, and less painful than
    central access. In patients taking anticoagulants, peripheral access allows for
    direct compression of puncture sites and fewer hematoma-related complications
    compared with the sites used for central venous catheters.",
    " </p>",
    " <p>",
    " Central venous catheters are often preferred in patients receiving sclerosing
    medications that can damage peripheral veins or being treated with vasopressors,
    which can cause injury if extravasated. Central venous access may also be
    preferable in patients with severe volume depletion or in whom peripheral venous
    catheter placement has a low likelihood of success (ie, frequent users of illicit
    IV drugs). (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?35/11/36024?
    source=see_link&amp;anchor=H3099781#H3099781\">",
    " \"Placement of femoral venous catheters\", section on 'Indications'",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?43/32/44553?
    source=see_link&amp;anchor=H3103243#H3103243\">",
    " \"Overview of central venous access\", section on 'Indications'",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H15275188\">",
    " <span class=\"h2\">",
    " Contraindications",
    " </span>",
    " &nbsp;&mdash;&nbsp;There are few contraindications to the placement of
    peripheral venous catheters. Most concern problems with cannulation at a specific
    site. The sole absolute contraindication is when appropriate therapy can be
    provided by a less invasive route (eg, orally). Guidelines about appropriate sites
    for the placement of peripheral venous catheters are described separately. (See",
    " <a class=\"local\" href=\"#H27755111\">",
    " 'Site selection'",
    " </a>",
    " below.)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H52513128\">",
    " <span class=\"h2\">",
    " Anticipated difficulty",
    " </span>",
    " &nbsp;&mdash;&nbsp;According to observational data, factors associated with
    difficulty placing a peripheral IV catheter in an adult include obesity,
    underweight, clinician inexperience, and clinician judgement of poor peripheral
    venous access [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/1-3\">",
    " 1-3",
    " </a>",
    " ]. In a prospective study of IV placement in 563 consecutive emergency
    department patients, difficult venous access was predicted by paucity or absence of
    visible or palpable peripheral veins [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/1\">",
    " 1",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " If difficulty is anticipated or apparent when it is critical to obtain access,
    alternative approaches include intraosseous and central venous catheters. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?39/51/40761?
    source=see_link\">",
    " \"Intraosseous infusion\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?3/14/3306?
    source=see_link\">",
    " \"Placement of jugular venous catheters\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?35/11/36024?
    source=see_link\">",
    " \"Placement of femoral venous catheters\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?1/27/1466?
    source=see_link\">",
    " \"Placement of subclavian venous catheters\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755096\">",
    " <span class=\"h1\">",
    " MATERIALS",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755104\">",
    " <span class=\"h2\">",
    " Equipment",
    " </span>",
    " &nbsp;&mdash;&nbsp;Necessary materials for obtaining peripheral venous access
    include:",
    " </p>",
    " <p>",
    " <ul class=\"bulletCompact-block\">",
    " <li>",
    " Peripheral venous catheters of appropriate size",
    " </li>",
    " <li>",
    " Connective tubing and IV fluid",
    " </li>",
    " <li>",
    " Skin preparation materials (eg,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?12/36/12870?
    source=see_link\">",
    " chlorhexidine",
    " </a>",
    " )",
    " </li>",
    " <li>",
    " Dressings",
    " </li>",
    " <li>",
    " Tape or a commercial device to secure the catheter",
    " </li>",
    " <li>",
    " Clean gloves and eye protection &nbsp;",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " If fluid administration is not required and the catheter is placed for
    intermittent therapy or anticipated need, a cap is placed atop the catheter. In
    such cases, a small syringe filled with a flushing solution (eg, isotonic saline)
    is required to ensure the catheter&rsquo;s patency.",
    " </p>",
    " <p>",
    " Other materials that may be needed when obtaining peripheral venous access
    include a topical anesthetic to minimize the pain of venipuncture, fluid warmers,
    and pressure infusers. If a catheter is placed over a joint, a splint may help to
    reduce movement and decrease the risk of dislodging the catheter.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2209344\">",
    " <span class=\"h2\">",
    " Catheters",
    " </span>",
    " &nbsp;&mdash;&nbsp;Intravenous (IV) catheters in common use today are pliable
    plastic tubes with an inner needle obturator (over-the-needle catheters) (",
    " <a class=\"graphic graphic_picture graphicRef55791 \" href=\"UTD.htm?
    23/12/23751\">",
    " picture 1",
    " </a>",
    " ) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/4\">",
    " 4",
    " </a>",
    " ]. Steel needles, such as butterfly needles, may be appropriate for blood
    draws, but should not be used for prolonged IV therapy due to the risk of vein
    injury and extravasation of fluids or medications [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/5\">",
    " 5",
    " </a>",
    " ]. Catheter material and the risk of phlebitis and infection are discussed
    separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?30/53/31578?
    source=see_link&amp;anchor=H10#H10\">",
    " \"Prevention of intravascular catheter-related infections\", section on
    'Catheter material'",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?26/26/27050?
    source=see_link&amp;anchor=H15#H15\">",
    " \"Catheter-induced upper extremity venous thrombosis\", section on
    'Phlebitis'",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Peripheral catheters range in size from 24 (smaller) to 14 (larger) gauges.
    Twenty-two to 20 gauge catheters are typically used for medication administration
    or infusion of moderate volumes of fluid. Infusion of large fluid volumes or blood
    products typically requires larger sizes (eg, 18 to 16 gauge). The smallest
    appropriate needle size should be used, as smaller catheters cause less trauma and
    phlebitis [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/6\">",
    " 6",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " Catheters range in length from 2 to 3 cm (0.75 to 1.25 inches). Longer
    catheters (5 to 15 cm; 2 to 6 inches) may be beneficial for placement proximal to
    the antecubital fossa by reducing the risk of dislodgement when the patient moves
    [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/7\">",
    " 7",
    " </a>",
    " ].",
    " <strong>",
    " </strong>",
    " To reduce the risk of injury, the needles in most catheters in current use can
    be retracted into a needle guard by pushing a button on the flashback chamber after
    the catheter is inserted [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/4\">",
    " 4",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755111\">",
    " <span class=\"h1\">",
    " SITE SELECTION",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2209385\">",
    " <span class=\"h2\">",
    " Guidelines",
    " </span>",
    " &nbsp;&mdash;&nbsp;Many sites can be used for peripheral intravenous (IV)
    access, and they vary in their ease of cannulation and potential risks. Site
    selection varies according to clinical circumstances, expected duration of
    treatment, and the condition of the extremities.",
    " </p>",
    " <p>",
    " In general, distal extremity sites should be used first, saving more proximal
    sites for subsequent cannulation, if needed. Placing an IV in a vein distal to a
    site that was previously punctured can lead to extravasation of fluids and hematoma
    formation. Larger veins are generally more easily cannulated and are preferable to
    smaller veins in the same region. Veins of the upper extremity are preferred due to
    the increased risk of thrombosis and thrombophlebitis with venous cannulation of
    the lower extremities [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/5,8,9\">",
    " 5,8,9",
    " </a>",
    " ]. Whenever possible, avoid using the dominant upper extremity.",
    " </p>",
    " <p>",
    " Sites over joints (eg, antecubital fossa) should be avoided if possible due to
    the increased risk of catheter dislodgement and kinking, and the need to then
    immobilize the joint to reduce these risks. Peripheral IV catheters used for trauma
    resuscitation are an exception to this rule and are routinely placed in the larger
    veins of the antecubital fossa. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/11/35002?
    source=see_link&amp;anchor=H1929754#H1929754\">",
    " \"Initial management of trauma in adults\", section on 'Circulation'",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Contraindications to the use of a particular extremity include the presence of
    an arteriovenous fistula (catheter can alter venous blood flow or damage the
    fistula) and a history of mastectomy or lymph node dissection (catheter can
    exacerbate impaired lymphatic drainage) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/5\">",
    " 5",
    " </a>",
    " ]. Venous catheter placement should be avoided at a site that may interfere
    with an anticipated procedure (eg, an injured extremity that requires surgery).",
    " </p>",
    " <p>",
    " Veins that are firm to palpation may be sclerosed (eg, from IV drug abuse) and
    should be avoided as should veins with evidence of phlebitis or thrombosis. Venous
    puncture at sites where catheter placement was recently attempted should also be
    avoided, especially if a hematoma formed (ie, vein was &ldquo;blown&rdquo;)
    following the previous attempt. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?42/25/43417?
    source=see_link&amp;anchor=H10#H10\">",
    " \"Superficial thrombophlebitis of the lower extremity\", section on 'Clinical
    features and diagnosis'",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Placement of an IV through infected tissue is not advised due to the risk of
    introducing a systemic infection. In addition, peripheral IV catheters should not
    be placed through burned tissue or in extremities with massive edema.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2209392\">",
    " <span class=\"h2\">",
    " Anatomy and vein selection",
    " </span>",
    " &nbsp;&mdash;&nbsp;The veins of the dorsum of the hand are often the most
    accessible sites for peripheral cannulation (",
    " <a class=\"graphic graphic_figure graphicRef70665 \" href=\"UTD.htm?
    43/15/44281\">",
    " figure 1",
    " </a>",
    " and",
    " <a class=\"graphic graphic_figure graphicRef55596 \" href=\"UTD.htm?
    18/3/18480\">",
    " figure 2",
    " </a>",
    " ). As an example, the dorsal metacarpal veins are usually visible and palpable
    and make good sites for IV catheter placement [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/5\">",
    " 5",
    " </a>",
    " ]. These veins merge into the dorsal venous network (or arch) and then form
    the cephalic vein, which runs along the lateral distal forearm. The cephalic vein
    is usually visible and palpable and therefore another good site for cannulation [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/10\">",
    " 10",
    " </a>",
    " ]. The volar forearm also contains several veins that can be cannulated,
    including the median antebrachial veins [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/11\">",
    " 11",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " The antecubital fossa, though not a primary choice for nonemergent IV access,
    contains several accessible veins, including the cephalic, median cubital, and
    basilic [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/11\">",
    " 11",
    " </a>",
    " ]. These veins are usually large and easily cannulated and provide a useful
    option when emergent IV access is needed. Veins in the proximal arm are more safely
    cannulated using ultrasound guidance. They include the more proximal portions of
    the basilic, cephalic, and brachial veins. If catheter placement is attempted in
    these proximal veins without ultrasound guidance, there is an increased risk of
    arterial puncture and nerve injury [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/12\">",
    " 12",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " In addition to the arm, leg and neck veins can be used to obtain peripheral IV
    access. The external jugular vein, which drains into the subclavian, is a large
    vein in the neck that is easily cannulated, even in patients with severe volume
    depletion or otherwise poor extremity access (",
    " <a class=\"graphic graphic_figure graphicRef53785 \" href=\"UTD.htm?
    41/3/42038\">",
    " figure 3",
    " </a>",
    " ) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/13\">",
    " 13",
    " </a>",
    " ]. Placing the patient&rsquo;s bed in a head-down (ie, Trendelenburg) position
    or having them perform a Valsalva maneuver often enlarges the vein making
    cannulation easier. When inserting the catheter, avoid the valves in the external
    jugular vein, which can impair function [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/14\">",
    " 14",
    " </a>",
    " ]. (See",
    " <a class=\"local\" href=\"#H27755140\">",
    " 'Vein dilation'",
    " </a>",
    " below.)",
    " </p>",
    " <p>",
    " Veins of the leg, including the greater saphenous vein at the level of the
    medial malleolus and the dorsal metatarsal veins on the dorsum of the foot, are
    often accessible [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/15\">",
    " 15",
    " </a>",
    " ]. However, lower extremity sites should be used only if veins in the arm
    cannot be cannulated (",
    " <a class=\"graphic graphic_figure graphicRef73200 \" href=\"UTD.htm?
    16/51/17210\">",
    " figure 4",
    " </a>",
    " ). (See",
    " <a class=\"local\" href=\"#H2209385\">",
    " 'Guidelines'",
    " </a>",
    " above.)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755118\">",
    " <span class=\"h1\">",
    " PREPARATION",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755126\">",
    " <span class=\"h2\">",
    " Consent",
    " </span>",
    " &nbsp;&mdash;&nbsp;Implied (presumed) consent is felt adequate for a procedure
    such as placement of a peripheral venous catheter where the risks and benefits are
    common knowledge to \"persons of average intelligence\" [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/16\">",
    " 16",
    " </a>",
    " ]. For IV catheter placement, consent can be assumed if the patient extends
    their arm for the procedure to be performed [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/17\">",
    " 17",
    " </a>",
    " ]. Some patients may be apprehensive about IV placement and in nonemergent
    cases, it is important to take some time to explain the reason for venous
    catheterization, risks and benefits, alternatives, expected duration of therapy,
    and the pain involved, and to allow the patient an opportunity to ask questions.",
    " </p>",
    " <p>",
    " Obtaining IV access in uncooperative patients is challenging. It is important
    to determine why the patient will not or cannot cooperate. If the patient lacks the
    capacity to make reasoned medical decisions and has a potentially life or limb-
    threatening condition requiring urgent intervention, the use of restraints may be
    necessary. Chemical restraint is preferred, but temporary use of physical
    restraints may be required. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?25/22/25962?
    source=see_link\">",
    " \"Assessment and management of the acutely agitated or violent adult\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " If the patient is alert and has capacity but will not cooperate due to fear or
    anxiety, provide reassurance. Administration of a short-acting anxiolytic (eg,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?3/60/4042?source=see_link\">",
    " midazolam",
    " </a>",
    " ) prior to the procedure may be beneficial, as may allowing a parent, family
    member, or friend to help comfort the patient.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755133\">",
    " <span class=\"h2\">",
    " Basic preparations",
    " </span>",
    " &nbsp;&mdash;&nbsp;Keep the patient warm and relaxed; both excessive cold and
    anxiety stimulate the sympathetic nervous system and can cause vasoconstriction of
    superficial vessels, thus making cannulation more difficult [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/18\">",
    " 18",
    " </a>",
    " ]. Patients who are excessively anxious may benefit from a small dose of a
    short-acting anxiolytic (eg,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?3/60/4042?source=see_link\">",
    " midazolam",
    " </a>",
    " ) prior to the procedure.",
    " </p>",
    " <p>",
    " Excessive hair around catheter sites may be clipped to ease cannulation and
    improve dressing adherence [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/5\">",
    " 5",
    " </a>",
    " ]. Do not shave hair because this increases the risk of infection [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/4\">",
    " 4",
    " </a>",
    " ]. If a topical anesthetic is used, allow sufficient time for it to take
    effect. If possible, use the patient&rsquo;s nondominant extremity to reduce
    inconvenience and the effect of extravasation, should it occur.",
    " </p>",
    " <p>",
    " The practitioner placing the IV and the patient should both be comfortable
    throughout the procedure. If possible, place patients in a supine position to avoid
    lightheadedness from pain or the sight of blood. Place the extremity with the
    venipuncture site on a stable surface below heart level to allow gravity to enhance
    venous dilation [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/19\">",
    " 19",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2209949\">",
    " <span class=\"h2\">",
    " Prevention of infection",
    " </span>",
    " &nbsp;&mdash;&nbsp;Before venipuncture is attempted, take appropriate steps to
    protect the patient and healthcare worker from infection. Wash your hands, and wear
    clean gloves and protective eye wear. Do not touch the puncture site after it has
    been cleaned with an appropriate solution (",
    " <a class=\"drug drug_general\" href=\"UTD.htm?12/36/12870?source=see_link\">",
    " chlorhexidine",
    " </a>",
    " ). Prevention of infection associated with IV catheters, including cleaning
    agents and sterile technique, is discussed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?30/53/31578?
    source=see_link\">",
    " \"Prevention of intravascular catheter-related infections\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755140\">",
    " <span class=\"h2\">",
    " Vein dilation",
    " </span>",
    " &nbsp;&mdash;&nbsp;Multiple methods for enhancing venous dilation to
    facilitate cannulation have been described [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/20\">",
    " 20",
    " </a>",
    " ]. Placing the anticipated cannulation site below the level of the heart uses
    gravity to reduce venous return, which causes blood to pool and veins to distend
    [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/21,22\">",
    " 21,22",
    " </a>",
    " ]. Lightly tapping or gently stroking the vein along its length in a proximal
    to distal direction causes venous distension [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/23,24\">",
    " 23,24",
    " </a>",
    " ]. Another simple, effective way to dilate veins consists of having the
    patient alternately clench and relax their fist [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/21\">",
    " 21",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " Elevating skin temperatures to 39&deg; to 42&deg;C at the cannulation site
    causes venous dilation. This can be accomplished by placing the site in warm water
    or by applying a warm compress (eg, warm moist cloths, warming packs, heated carbon
    fiber mitts) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/21,22,25-27\">",
    " 21,22,25-27",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " Proximal compression, most often using a thin rubber tourniquet placed 5 to 10
    cm proximal to the anticipated venipuncture site, impedes venous return and
    enhances venous dilation [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/21\">",
    " 21",
    " </a>",
    " ]. Tourniquet pressures should be greater than venous pressure, but less than
    arterial pressure to allow arterial inflow [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/21,25\">",
    " 21,25",
    " </a>",
    " ]. Other devices similar to tourniquets may be used, such as blood pressure
    cuffs and Esmarch bandages. If a blood pressure cuff is used, inflate it no higher
    than the diastolic blood pressure [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/28-30\">",
    " 28-30",
    " </a>",
    " ]. Avoid excessive pressure and prolonged application of the tourniquet to
    reduce the risk of vein injury and hematoma formation, especially in the elderly
    [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/31\">",
    " 31",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " An Esmarch bandage is similar to the rubber tourniquets commonly used, but is
    7.5 to 25 cm (3 to 10 inches) in width, and each roll is several hundred
    centimeters long. The Esmarch bandage is placed at the proximal end of the involved
    limb, and the limb is then wrapped circumferentially in a proximal to distal
    direction [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/32\">",
    " 32",
    " </a>",
    " ]. This squeezes blood from the proximal to the distal end of the limb,
    thereby dilating the veins.",
    " </p>",
    " <p>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?11/24/11656?source=see_link\">",
    " Nitroglycerin",
    " </a>",
    " ointment applied to the venipuncture site and left for two minutes causes
    venous dilation and does not appear to cause deleterious changes in blood pressure,
    even in hypotensive patients [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/33\">",
    " 33",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " For the placement of larger intravenous (IV) catheters, a technique for
    dilating veins similar to Bier block regional anesthesia has been described [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/34\">",
    " 34",
    " </a>",
    " ]. After a small gauge IV catheter is placed, usually in the hand, the
    tourniquet is left in place. A volume of isotonic crystalloid (60 to 300 mL) is
    then infused. This fluid distends the surrounding collateral veins, allowing for
    placement of a larger gauge catheter.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2663664\">",
    " <span class=\"h2\">",
    " Tools for locating veins",
    " </span>",
    " &nbsp;&mdash;&nbsp;When no veins are readily visible or palpable, any of
    several transillumination devices can be used to locate veins for cannulation. One
    such device uses infrared light, which reflects off tissue surrounding the veins,
    but not the vein itself (eg, The VeinViewer&reg;, Luminetx, Memphis, TN) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/35\">",
    " 35",
    " </a>",
    " ]. Other devices use a light frequency that causes deoxygenated venous blood
    to appear darker than surrounding tissues (eg, Veinlite LED&reg;, TransLite,
    Sugarland, TX) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/35\">",
    " 35",
    " </a>",
    " ]. In patients with veins not easily seen or palpated, Doppler ultrasound can
    be used to identify veins larger than 2 mm [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/36\">",
    " 36",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?3/47/3833?
    source=see_link\">",
    " \"Principles of ultrasound-guided venous access\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755147\">",
    " <span class=\"h2\">",
    " Analgesia",
    " </span>",
    " &nbsp;&mdash;&nbsp;Venipuncture is a painful procedure, but analgesia is not
    routinely provided outside the operating theater [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/37\">",
    " 37",
    " </a>",
    " ]. Nevertheless, topical and subcutaneous anesthetics reduce the pain and
    anxiety associated with IV catheter insertion, and they should be used whenever
    possible. Multiple methods are available for providing analgesia prior to
    venipuncture, including intradermal injection, topical medication, and technologies
    such as iontophoresis. A thorough discussion of topical anesthetics is found
    separately; a brief description of selected analgesic techniques for peripheral
    venous cannulation is provided here. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?42/50/43817?
    source=see_link\">",
    " \"Topical anesthetics in children\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Intradermally injected local anesthetics are the traditional method of
    anesthetizing a puncture site. One percent buffered",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/34/35360?source=see_link\">",
    " lidocaine",
    " </a>",
    " injected subcutaneously provides rapid anesthesia and does not appear to
    decrease successful catheter placement [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/38\">",
    " 38",
    " </a>",
    " ]. This method reduces the pain from venipuncture, but involves a separate
    injection, which itself can cause pain, anxiety, and may distort puncture site
    anatomy [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/39-42\">",
    " 39-42",
    " </a>",
    " ]. Avoid intradermal anesthetics that contain epinephrine, which can cause the
    vein to constrict [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/43\">",
    " 43",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " A number of topical anesthetics can be used to reduce the pain of
    venipuncture:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " EMLA, the eutectic mixture of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/34/35360?
    source=see_link\">",
    " lidocaine",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?6/32/6660?source=see_link\">",
    " prilocaine",
    " </a>",
    " , reduces pain but requires approximately one hour to achieve peak effect.
    If used, 1 to 2 grams should be applied per 10 cm",
    " <sup>",
    " 2",
    " </sup>",
    " of skin and then covered with an occlusive dressing. EMLA is generally safe,
    but can cause methemoglobinemia with prolonged use or in those who are predisposed.
    (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?42/50/43817?
    source=see_link&amp;anchor=H11#H11\">",
    " \"Topical anesthetics in children\", section on 'EMLA'",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " LMX&trade; (formerly ELA-max) is a topical preparation of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/34/35360?
    source=see_link\">",
    " lidocaine",
    " </a>",
    " encapsulated in liposomes, which are spherical, microscopic, phospholipid-
    based carriers that promote passage of the anesthetic through intact skin. LMX
    appears to have similar efficacy to EMLA in preventing pain from venipuncture, but
    takes only 30 minutes to exert its effect. Dosing is similar to EMLA: apply 1 to 2
    grams per 10 cm",
    " <sup>",
    " 2",
    " </sup>",
    " of skin. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?42/50/43817?
    source=see_link&amp;anchor=H21#H21\">",
    " \"Topical anesthetics in children\", section on 'Liposomal lidocaine'",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?35/12/36032?
    source=see_link\">",
    " Tetracaine",
    " </a>",
    " , an ester anesthetic, can be applied as a 4 percent cream, a 5 percent gel
    (Amethocaine), or a 5 percent liposomal encapsulated cream (LET). Its efficacy and
    time of onset are similar to EMLA. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?42/50/43817?
    source=see_link&amp;anchor=H2#H2\">",
    " \"Topical anesthetics in children\", section on 'LET'",
    " </a>",
    " .)",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " Each method above has advantages and disadvantages, but all seem to provide
    similar degrees of anesthesia [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/44\">",
    " 44",
    " </a>",
    " ]. If time allows, topical agents are a good approach, but they may require 30
    to 60 minutes to achieve maximum effect.",
    " </p>",
    " <p>",
    " Iontophoresis, the application of a small electrical current to move ionized",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/34/35360?source=see_link\">",
    " lidocaine",
    " </a>",
    " through intact skin, has been used to provide local analgesia. Iontophoresis
    provides pain relief from venipuncture within 10 to 20 minutes. The technique can
    cause minor skin irritation and blistering. Similarly, sonophoresis, the use of low
    frequency ultrasound to facilitate skin penetration of a local anesthetic, has been
    shown to be fast (15 to 20 seconds of ultrasound time followed by five minutes of
    local anesthetic application) and effective in reducing pain from venipuncture [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/45,46\">",
    " 45,46",
    " </a>",
    " ]. A disadvantage of such techniques is the need for relatively expensive
    equipment.",
    " </p>",
    " <p>",
    " Researchers have assessed the use of a single pulse of an erbium: yttrium-
    aluminum-garnet laser to remove the stratum corneum, thereby improving the
    penetration of local anesthetic. While the technique was found to reduce the pain
    of IV cannulation in volunteers within minutes, the cost of the laser device is
    prohibitive (approximately $2000 US) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/47\">",
    " 47",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755154\">",
    " <span class=\"h1\">",
    " CATHETER INSERTION",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755162\">",
    " <span class=\"h2\">",
    " Traditional percutaneous technique",
    " </span>",
    " &nbsp;&mdash;&nbsp;Once an appropriate site is selected, use the following
    technique to place the catheter:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Place a tourniquet proximal to the intended site (",
    " <a class=\"graphic graphic_picture graphicRef62529 \" href=\"UTD.htm?
    34/25/35217\">",
    " picture 2",
    " </a>",
    " ).",
    " </li>",
    " <li>",
    " Cleanse the skin, being careful not to contaminate the puncture site after
    the skin is cleansed. A local anaesthetic may be injected (",
    " <a class=\"graphic graphic_picture graphicRef75311 \" href=\"UTD.htm?
    31/55/32624\">",
    " picture 3",
    " </a>",
    " ).",
    " </li>",
    " <li>",
    " Hold the area steady with the nondominant hand, and use the thumb to pull
    gently on the vein. This reduces movement of the vein when inserting the needle.
    Avoid applying excessive pressure, which will collapse the vein.",
    " </li>",
    " <li>",
    " Hold the catheter in the dominant hand between the thumb and forefinger with
    the bevel facing upwards (",
    " <a class=\"graphic graphic_picture graphicRef57369 \" href=\"UTD.htm?
    10/3/10289\">",
    " picture 4",
    " </a>",
    " ).",
    " </li>",
    " <li>",
    " Approach the vein with the needle at a low angle, generally about 10 to 30
    degrees from the skin surface. Puncture the skin, and enter the vein using a slow,
    smooth, continuous movement. A flash of blood in the flash back chamber of the
    catheter indicates that the needle has entered the vein.",
    " </li>",
    " <li>",
    " Advance the catheter another 1 to 2 millimeters to ensure that the catheter
    tip, which sits back slightly from the needle lumen, lies completely within the
    vein (",
    " <a class=\"graphic graphic_picture graphicRef70200 \" href=\"UTD.htm?
    3/45/3793\">",
    " picture 5",
    " </a>",
    " ).",
    " </li>",
    " <li>",
    " Place the tip of the dominant index finger against the small tab that
    extends up from the top of the hub of the catheter. Advance the catheter into the
    vein by extending the dominant index finger, thereby exerting pressure against the
    small tab with the fingertip. Maintain slight traction on the vein with the
    nondominant hand to prevent vein movement while the catheter advances. If the
    catheter is within the vessel lumen, it should advance easily and relatively
    painlessly (",
    " <a class=\"graphic graphic_picture graphicRef82130 \" href=\"UTD.htm?
    16/13/16592\">",
    " picture 6",
    " </a>",
    " ).",
    " </li>",
    " <li>",
    " If you cannot advance the catheter, it has either been advanced too far
    through the posterior wall of the vein, or the needle entered the vein but the
    catheter did not. If you suspect the former situation, withdraw the needle slightly
    until you see a good blood flash in the hub, and then try advancing the catheter.
    If you suspect the latter situation, advance the needle slightly, and then try to
    advance the catheter. In many cases, you must abort the attempt at cannulation if
    these problems arise, and try a different site, proximal to the first if the same
    extremity is used.",
    " </li>",
    " <li>",
    " Occasionally, the catheter is in the lumen of the vein, but cannot be
    advanced because it lies against a valve or tortuous portion of the vein. If you
    suspect this, attach a syringe filled with isotonic saline to the catheter, and
    gently infuse fluid through the catheter while slowly advancing it. This problem
    can often be avoided by using relatively straight veins and by avoiding valves
    which are often visible as small, circumscribed bulges in the vein.",
    " </li>",
    " <li>",
    " If the IV catheter is appropriately placed, venous blood will flow steadily
    from the catheter, and no swelling will occur at the puncture site. Once the
    catheter has been inserted, push the button on the needle guard to allow the needle
    to be retracted and to prevent inadvertent needle stick injuries. Remove the
    tourniquet, secure the catheter, and attach the appropriate IV set up. If correctly
    placed, medicine or fluids should infuse easily, without pain or swelling at the
    catheter site (",
    " <a class=\"graphic graphic_picture graphicRef56946 \" href=\"UTD.htm?
    36/28/37315\">",
    " picture 7",
    " </a>",
    " ).",
    " </li>",
    " <li>",
    " If swelling occurs and extravenous placement is suspected, remove the
    catheter, and apply pressure at the puncture site to reduce hematoma formation;
    then place a dressing over the puncture site.",
    " </li>",
    " <li>",
    " Inadvertent arterial catheter placement usually causes a pulsatile flow of
    bright red blood and produces an arterial wave form when a transducer is attached.
    If this occurs, remove the catheter and apply continuous pressure at the puncture
    site for approximately 10 minutes.",
    " </li>",
    " <li>",
    " When the procedure is completed, place all sharp objects in the proper
    container, and dispose of other materials appropriately (",
    " <a class=\"graphic graphic_picture graphicRef67731 \" href=\"UTD.htm?
    31/63/32752\">",
    " picture 8",
    " </a>",
    " ).",
    " </li>",
    " </ul>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755169\">",
    " <span class=\"h2\">",
    " Ultrasound guided",
    " </span>",
    " &nbsp;&mdash;&nbsp;Ultrasound has become a useful adjunct in the performance
    of many medical procedures, including placement of central and peripheral venous
    catheters. The use of ultrasound in the placement of peripheral venous catheters is
    described separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?3/47/3833?
    source=see_link\">",
    " \"Principles of ultrasound-guided venous access\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2209581\">",
    " <span class=\"h1\">",
    " POST-PLACEMENT CARE",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755176\">",
    " <span class=\"h2\">",
    " Securing the catheter",
    " </span>",
    " &nbsp;&mdash;&nbsp;Once the catheter is placed, secure it well to avoid
    dislodgement, which can cause extravasation of potentially harmful IV fluids and
    medications. In addition, movement of a poorly secured catheter may increase the
    risk of thrombophlebitis [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/48\">",
    " 48",
    " </a>",
    " ]. If the IV catheter must be placed over a joint or in a dominant hand, it is
    often helpful to place a splint. Selection of an appropriate site for catheter
    placement is discussed above. (See",
    " <a class=\"local\" href=\"#H27755111\">",
    " 'Site selection'",
    " </a>",
    " above.)",
    " </p>",
    " <p>",
    " Peripheral catheters can be secured with tape, prefabricated adhesive
    dressings (eg, Opsite&trade;, Smith and Nephew, UK; Tegaderm&trade;, 3M, St. Paul,
    MN), suture, or specific IV securing devices. The relative advantages and
    disadvantages of these methods are discussed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?30/53/31578?
    source=see_link&amp;anchor=H17#H17\">",
    " \"Prevention of intravascular catheter-related infections\", section on 'Site
    care'",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755183\">",
    " <span class=\"h2\">",
    " Maintaining patency",
    " </span>",
    " &nbsp;&mdash;&nbsp;Peripheral IV catheters placed for intermittent therapy
    (INT) require occasional flushing to keep them patent. This is not a concern when
    catheters are used for continuous infusions. Previously, dilute",
    " <a class=\"drug drug_general\" href=\"UTD.htm?39/34/40489?source=see_link\">",
    " heparin",
    " </a>",
    " solutions were used to flush catheters, thus the term \"heparin lock.&rdquo;
    Multiple studies have found that periodic flushing with isotonic saline is equally
    effective in maintaining the patency of catheters used for INT, while avoiding
    heparin-related complications [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/49-53\">",
    " 49-53",
    " </a>",
    " ]. No studies address the issue of how best to flush peripheral catheters with
    saline, but common practice is to use 2 to 10 mL of isotonic saline after any IV
    medication is given or every 4 to 12 hours [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/54\">",
    " 54",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H2209609\">",
    " <span class=\"h2\">",
    " Monitoring",
    " </span>",
    " &nbsp;&mdash;&nbsp;After an IV has been successfully placed, clinicians should
    periodically reassess the catheter to verify proper placement and patency. Examine
    the site carefully if any redness, edema, pain, tenderness, or problems infusing
    develop. Ultrasound can be used to verify the catheter&rsquo;s position.",
    " </p>",
    " <p>",
    " Extravasation of fluid usually manifests as swelling and pain at the site and
    slow infusion rates. If IV fluids no longer infuse via gravity and the catheter
    cannot be flushed easily, a clot may have formed within the catheter. Do not flush
    the catheter forcefully because this can dislodge a clot into the circulation and
    should not be done.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755190\">",
    " <span class=\"h1\">",
    " COMPLICATIONS",
    " </span>",
    " &nbsp;&mdash;&nbsp;When performed properly, peripheral IV placement is a safe
    procedure with little serious risk. Nevertheless, a number of potential
    complications have been described. Among the more common complications are
    phlebitis, extravasation of IV fluids, bruising, and hematoma formation [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/14\">",
    " 14",
    " </a>",
    " ]. Thrombophlebitis occurs in up to 15 percent of those with peripheral venous
    catheters [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/55\">",
    " 55",
    " </a>",
    " ]. This risk can be reduced by avoiding lower extremity IV placement,
    minimizing catheter movement, placing the smallest suitable catheter size, and
    removing the catheter as soon as possible [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/56-58\">",
    " 56-58",
    " </a>",
    " ]. Catheters placed in emergency circumstances are more prone to
    complications.",
    " </p>",
    " <p>",
    " Peripheral venous catheters are thought to be rare causes of blood stream
    infections. The risk of infection from peripheral IV catheters and the practice of
    using a fixed schedule (eg, three days) to replace catheters are discussed
    separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?30/53/31578?
    source=see_link&amp;anchor=H5#H5\">",
    " \"Prevention of intravascular catheter-related infections\", section on
    'Duration'",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Less commonly reported complications include septic discitis [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/59\">",
    " 59",
    " </a>",
    " ], venous air embolism, pneumocephalus [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/60\">",
    " 60",
    " </a>",
    " ], DVT [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/61\">",
    " 61",
    " </a>",
    " ], skin necrosis [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/62\">",
    " 62",
    " </a>",
    " ], bacteremia [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/63\">",
    " 63",
    " </a>",
    " ], compartment syndrome, nerve injury, arterial injury [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/64\">",
    " 64",
    " </a>",
    " ], tendon injury, and venous aneurysm formation [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6361/abstract/14,65\">",
    " 14,65",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H27755204\">",
    " <span class=\"h1\">",
    " SUMMARY AND RECOMMENDATIONS",
    " </span>",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " IV catheters should be placed when less invasive forms of therapy are not
    appropriate. &nbsp;",
    " </li>",
    " <li>",
    " Catheter selection varies according to the patient's condition and intended
    use. (See",
    " <a class=\"local\" href=\"#H2663520\">",
    " 'Indications, contraindications, and difficulty'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " Depending upon clinical circumstances, we suggest using a local anesthetic
    prior to venipuncture. (See",
    " <a class=\"local\" href=\"#H27755147\">",
    " 'Analgesia'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " Ideally, peripheral IV catheters are placed in distal veins in the upper
    extremity. (See",
    " <a class=\"local\" href=\"#H27755111\">",
    " 'Site selection'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " Methods to enhance venous dilation and successful cannulation are included
    in the text. (See",
    " <a class=\"local\" href=\"#H27755140\">",
    " 'Vein dilation'",
    " </a>",
    " above and",
    " <a class=\"local\" href=\"#H27755162\">",
    " 'Traditional percutaneous technique'",
    " </a>",
    " above.) &nbsp;",
    " </li>",
    " <li>",
    " Localized pain or swelling or impaired infusate flow suggest a complication
    with the catheter, which should be carefully examined. (See",
    " <a class=\"local\" href=\"#H2209609\">",
    " 'Monitoring'",
    " </a>",
    " above and",
    " <a class=\"local\" href=\"#H27755190\">",
    " 'Complications'",
    " </a>",
    " above.)",
    " </li>",
    " </ul>",
    " </p>",
    " </div>",
    " <div id=\"topicAgreement\">",
    " Use of UpToDate is subject to the",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_in_page\"
    target=\"_blank\">",
    " Subscription and License Agreement",
    " </a>",
    " .",
    " </div>",
    " <div class=\"headingAnchor\" id=\"references\">",
    " <h1>",
    " REFERENCES",
    " </h1>",
    " <ol id=\"reference\">",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/1\">",
    " Sebbane M, Claret PG, Lefebvre S, et al. Predicting peripheral venous access
    difficulty in the emergency department using body mass index and a clinical
    evaluation of venous accessibility. J Emerg Med 2013; 44:299.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/2\">",
    " Juvin P, Blarel A, Bruno F, Desmonts JM. Is peripheral line placement more
    difficult in obese than in lean patients? Anesth Analg 2003; 96:1218, table of
    contents.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/3\">",
    " Jacobson AF, Winslow EH. Variables influencing intravenous catheter
    insertion difficulty and failure: an analysis of 339 intravenous catheter
    insertions. Heart Lung 2005; 34:345.",
    " </a>",
    " </li>",
    " <li>",
    " Adams, J. Intravenous and vascular access therapy. In: Clinical Nursing
    Skills and Techniques, Perry, AG, Potter, PA (Eds), Mosby, St. Louis 2006. p.898.",
    " </li>",
    " <li>",
    " Mulvey, MA. Fluid and electrolytes: balance and disturbance. In: Brunner and
    Suddarth's Textbook of Medical-Surgical Nursing, 11th, Smeltzer, SC, Bare, BG,
    Hinkle, JL, et al (Eds), Lippincott Williams and Wilkins, Philadelphia 2008.
    p.300.",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/6\">",
    " Crow S. Prevention of intravascular infections ways and means. J Intraven
    Nurs 1996; 19:175.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/7\">",
    " Sandhu NP, Sidhu DS. Mid-arm approach to basilic and cephalic vein
    cannulation using ultrasound guidance. Br J Anaesth 2004; 93:292.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/8\">",
    " Tager IB, Ginsberg MB, Ellis SE, et al. An epidemiologic study of the risks
    associated with peripheral intravenous catheters. Am J Epidemiol 1983; 118:839.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/9\">",
    " Clutton-Brock TH. Vascular access. How to set up a drip and keep it going.
    Br J Hosp Med 1984; 32:162, 164, 166.",
    " </a>",
    " </li>",
    " <li>",
    " Gray, H. Wrist and Hand. In: Gray's Anatomy: The Anatomical Basis of Clinical
    Practice, 39th, Standring, S, Ellis, H, Healy, JC (Eds), Church Livingstone,
    Philadelphia 2005. p.889.",
    " </li>",
    " <li>",
    " Moore, KL, Dalley, AF. Clinically Oriented Anatomy, 4th, Lippincott Williams
    and Wilkins, Philadelphia 1999. p.665.",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/12\">",
    " Kramer, DA, Staten-McCormick, M, Freeman, SB. Percutaneous brachial vein
    catheterization: an alternate site for intravenous access. [abstract 38]. Ann Emerg
    Med 1983; 12:247.",
    " </a>",
    " </li>",
    " <li>",
    " Agur, AM, Lee, MJ. Grant's Atlas of Anatomy, 9th, Williams and Wilkins,
    Baltimore 1991. p.549.",
    " </li>",
    " <li>",
    " Liu, SW, Zane, RD. Peripheral intravenous access. In: Clinical Procedures in
    Emergency Medicine, 4th, Roberts, JR, Hedges, JR (Eds), Saunders, Philadelphia
    2004. p.401.",
    " </li>",
    " <li>",
    " Netter, FH. Atlast of Human Anatomy, 3rd, Icon Learning Systems, Teterboro
    2003.",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/16\">",
    " Iserson KV. Is informed consent required for the administration of
    intravenous contrast and similar clinical procedures? Ann Emerg Med 2007; 49:231.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/17\">",
    " Scales K. Vascular access: a guide to peripheral venous cannulation. Nurs
    Stand 2005; 19:48.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/18\">",
    " Pang CC. Autonomic control of the venous system in health and disease:
    effects of drugs. Pharmacol Ther 2001; 90:179.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/19\">",
    " Trimble T. Peripheral i.v. starts: securing and removing the catheter.
    Nursing 2003; 33:26.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/20\">",
    " Roberge RJ. Venodilatation techniques to enhance venepuncture and
    intravenous cannulation. J Emerg Med 2004; 27:69.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/21\">",
    " Mbamalu D, Banerjee A. Methods of obtaining peripheral venous access in
    difficult situations. Postgrad Med J 1999; 75:459.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/22\">",
    " Millam DA. Tips for improving your venipuncture techniques. Nursing 1987;
    17:46.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/23\">",
    " Hedges JR, Weinshenker E, Dirksing R. Evaluation of venous distension
    device: potential aid for intravenous cannulation. Ann Emerg Med 1986; 15:540.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/24\">",
    " Kindgen-Milles D, Arndt JO. Nitric oxide as a chemical link in the
    generation of pain from veins in humans. Pain 1996; 64:139.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/25\">",
    " Campbell J. Making sense of the technique of venepuncture. Nurs Times 1995;
    91:29.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/26\">",
    " Lenhardt R, Seybold T, Kimberger O, et al. Local warming and insertion of
    peripheral venous cannulas: single blinded prospective randomised controlled trial
    and single blinded randomised crossover trial. BMJ 2002; 325:409.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/27\">",
    " Beer J. Local warming does help when inserting cannulas. BMJ 2002;
    325:1038.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/28\">",
    " Roberts GH, Carson J. Venipuncture tips for radiologic technologists. Radiol
    Technol 1993; 65:107.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/29\">",
    " Datta S, Hanning CD. How to insert a peripheral venous cannula. Br J Hosp
    Med 1990; 43:67.",
    " </a>",
    " </li>",
    " <li>",
    " Graza, D, Becan-Mcbride, K. Phlebotomy Handbook, Appleton and Lange, Stamford
    1996. p.134.",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/31\">",
    " Moureau NL. Tips for inserting an i.v. in an older patient. Nursing 2004;
    34:18.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/32\">",
    " Murray WB. The reverse Esmarch bandage for venous access. S Afr Med J 1993;
    83:440.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/33\">",
    " Roberge RJ, Kelly M, Evans TC, et al. Facilitated intravenous access through
    local application of nitroglycerin ointment. Ann Emerg Med 1987; 16:546.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/34\">",
    " Stein JI. A new technique for obtaining large-bore peripheral intravenous
    access. Anesthesiology 2005; 103:670.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/35\">",
    " Krueger A. Need help finding a vein? Nursing 2007; 37:39.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/36\">",
    " Whiteley MS, Chang BY, Marsh HP, et al. Use of hand-held Doppler to identify
    'difficult' forearm veins for cannulation. Ann R Coll Surg Engl 1995; 77:224.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/37\">",
    " Sado DM, Deakin CD. Local anaesthesia for venous cannulation and arterial
    blood gas sampling: are doctors using it? J R Soc Med 2005; 98:158.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/38\">",
    " McNaughton C, Zhou C, Robert L, et al. A randomized, crossover comparison of
    injected buffered lidocaine, lidocaine cream, and no analgesia for peripheral
    intravenous cannula insertion. Ann Emerg Med 2009; 54:214.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/39\">",
    " Langham BT, Harrison DA. Local anaesthetic: does it really reduce the pain
    of insertion of all sizes of venous cannula? Anaesthesia 1992; 47:890.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/40\">",
    " Harrison N, Langham BT, Bogod DG. Appropriate use of local anaesthetic for
    venous cannulation. Anaesthesia 1992; 47:210.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/41\">",
    " Kundu S, Achar S. Principles of office anesthesia: part II. Topical
    anesthesia. Am Fam Physician 2002; 66:99.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/42\">",
    " Brown J, Larson M. Pain during insertion of peripheral intravenous catheters
    with and without intradermal lidocaine. Clin Nurse Spec 1999; 13:283.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/43\">",
    " Smith DW, Peterson MR, DeBerard SC. Local anesthesia. Topical application,
    local infiltration, and field block. Postgrad Med 1999; 106:57.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/44\">",
    " Eidelman A, Weiss JM, Lau J, Carr DB. Topical anesthetics for dermal
    instrumentation: a systematic review of randomized, controlled trials. Ann Emerg
    Med 2005; 46:343.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/45\">",
    " Singer AJ, Homan CS, Church AL, McClain SA. Low-frequency sonophoresis:
    pathologic and thermal effects in dogs. Acad Emerg Med 1998; 5:35.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/46\">",
    " Becker BM, Helfrich S, Baker E, et al. Ultrasound with topical anesthetic
    rapidly decreases pain of intravenous cannulation. Acad Emerg Med 2005; 12:289.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/47\">",
    " Singer AJ, Regev R, Weeks R, Tlockowski DS. Laser-assisted anesthesia prior
    to intravenous cannulation in volunteers: a randomized, controlled trial. Acad
    Emerg Med 2005; 12:804.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/48\">",
    " Sheppard K, LeDesma M, Morris NL, O'Connor K. A prospective study of two
    intravenous catheter securement techniques in a skilled nursing facility. J
    Intraven Nurs 1999; 22:151.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/49\">",
    " Dougherty L. Reducing the risk of complications in i.v. therapy. Nurs Stand
    1997; 12:40.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/50\">",
    " Goode CJ, Titler M, Rakel B, et al. A meta-analysis of effects of heparin
    flush and saline flush: quality and cost implications. Nurs Res 1991; 40:324.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/51\">",
    " Dunn DL, Lenihan SF. The case for the saline flush. Am J Nurs 1987;
    87:798.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/52\">",
    " Maki DG, Botticelli JT, LeRoy ML, Thielke TS. Prospective study of replacing
    administration sets for intravenous therapy at 48- vs 72-hour intervals. 72 hours
    is safe and cost-effective. JAMA 1987; 258:1777.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/53\">",
    " Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in
    peripheral venous and arterial catheters: systematic review and meta-analysis of
    randomised controlled trials. BMJ 1998; 316:969.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/54\">",
    " Fernandez RS, Griffiths RD, Murie P. Peripheral venous catheters: a review
    of current practices. J Infus Nurs 2003; 26:388.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/55\">",
    " Monreal M, Oller B, Rodriguez N, et al. Infusion phlebitis in post-operative
    patients: when and why. Haemostasis 1999; 29:247.",
    " </a>",
    " </li>",
    " <li>",
    " Weinstein, SM. Plumer's Principles and Practice of Intravenous Therapy, 7th,
    Lippincott Williams &amp; Wilkins, Philadelphia 2001.",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/57\">",
    " Haddad FG, Waked CH, Zein EF. Peripheral venous catheter-related
    inflammation. A randomized prospective trial. J Med Liban 2006; 54:139.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/58\">",
    " Singh R, Bhandary S, Pun KD. Peripheral intravenous catheter related
    phlebitis and its contributing factors among adult population at KU Teaching
    Hospital. Kathmandu Univ Med J (KUMJ) 2008; 6:443.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/59\">",
    " Greig JM, Ellis CJ, Smith EG. Septic discitis and other complications of
    peripheral venous cannulation. QJM 2002; 95:412.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/60\">",
    " Yildiz A, Ozer C, Egilmez H, et al. Iatrogenic intravascular pneumocephalus
    secondary to intravenous catheterization. Eur Radiol 2002; 12:671.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/61\">",
    " Dubois J, Rypens F, Garel L, et al. Incidence of deep vein thrombosis
    related to peripherally inserted central catheters in children and adolescents.
    CMAJ 2007; 177:1185.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/62\">",
    " Kagel EM, Rayan GM. Intravenous catheter complications in the hand and
    forearm. J Trauma 2004; 56:123.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/63\">",
    " Pujol M, Hornero A, Saballs M, et al. Clinical epidemiology and outcomes of
    peripheral venous catheter-related bloodstream infections at a university-
    affiliated hospital. J Hosp Infect 2007; 67:22.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/64\">",
    " Lirk P, Keller C, Colvin J, et al. Unintentional arterial puncture during
    cephalic vein cannulation: case report and anatomical study. Br J Anaesth 2004;
    92:740.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6361/abstract/65\">",
    " Debnath D, Wallace S, Mylona E, Myint F. Aneurysm of antecubital vein: an
    unusual complication of peripheral intravenous cannulation. BMC Surg 2007; 7:9.",
    " </a>",
    " </li>",
    " </ol>",
    " </div>",
    " <div id=\"topicVersionRevision\">",
    " Topic 13824 Version 6.0",
    " </div>",
    " </div>",
    " <div id=\"footer\">",
    " <div id=\"supportFooter\">",
    " <span class=\"sfInfo\">",
    " &copy; 2013 UpToDate, Inc. All rights reserved.",
    " </span>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_footer\">",
    " Subscription and License Agreement",
    " </a>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Release: 21.6- C21.56",
    " </span>",
    " <br/>",
    " <span class=\"sfInfo\">",
    " Licensed to:",
    " <span class=\"emphasis\">",
    " AsanBook Dig. Med. Lib.",
    " </span>",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Support Tag: [0503-61.234.146.186-D40D2B0C78-S244013.14]",
    " <br/>",
    " </span>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6361=[""].join("\n");
    var outline_f6_13_6361=[" <div id=\"toggleOutline\">",
    " <a href=\"#\" title=\"Collapse Topic Outline\">",
    " <img alt=\"\" src=\"./../images/orange_arrow_left.myextg\"/>",
    " </a>",
    " </div>",
    " <div id=\"innerOutline\">",
    " <h1>",
    " TOPIC OUTLINE",
    " </h1>",
    " <div id=\"outline\">",
    " <ul>",
    " <li>",
    " <a class=\"sr_button\" href=\"#H27755204\" id=\"summRecButton\">",
    " <span>",
    " SUMMARY &amp; RECOMMENDATIONS",
    " </span>",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H27755068\">",
    " INTRODUCTION",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H2663520\">",
    " INDICATIONS, CONTRAINDICATIONS, AND DIFFICULTY",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755075\">",
    " Indications for venous access",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755089\">",
    " Indications for peripheral versus central venous access",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H15275188\">",
    " Contraindications",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H52513128\">",
    " Anticipated difficulty",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H27755096\">",
    " MATERIALS",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755104\">",
    " Equipment",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H2209344\">",
    " Catheters",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H27755111\">",
    " SITE SELECTION",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H2209385\">",
    " Guidelines",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H2209392\">",
    " Anatomy and vein selection",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H27755118\">",
    " PREPARATION",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755126\">",
    " Consent",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755133\">",
    " Basic preparations",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H2209949\">",
    " Prevention of infection",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755140\">",
    " Vein dilation",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H2663664\">",
    " Tools for locating veins",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755147\">",
    " Analgesia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H27755154\">",
    " CATHETER INSERTION",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755162\">",
    " Traditional percutaneous technique",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755169\">",
    " Ultrasound guided",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H2209581\">",
    " POST-PLACEMENT CARE",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755176\">",
    " Securing the catheter",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H27755183\">",
    " Maintaining patency",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H2209609\">",
    " Monitoring",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H27755190\">",
    " COMPLICATIONS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H27755204\">",
    " SUMMARY AND RECOMMENDATIONS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a href=\"#references\">",
    " REFERENCES",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " <div class=\"openRelatedGraphics\" id=\"EM/13824\" rel=\"outline_link\">",
    " GRAPHICS",
    " <a class=\"graphics_icon\" href=\"#\" title=\"View All Related Graphics\">",
    " View All",
    " </a>",
    " </div>",
    " </h1>",
    " <div id=\"relatedGraphics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <div class=\"openRelatedGraphics\" id=\"EM/13824|FIG\">",
    " <a href=\"#\" title=\"FIGURES\">",
    " FIGURES",
    " </a>",
    " </div>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_figure\" href=\"UTD.htm?43/15/44281\"
    title=\"figure 1\">",
    " Superficial veins of hand and forearm",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_figure\" href=\"UTD.htm?18/3/18480\"
    title=\"figure 2\">",
    " Anterior view superficial veins of the upper extremity",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_figure\" href=\"UTD.htm?41/3/42038\"
    title=\"figure 3\">",
    " Superficial veins of neck",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_figure\" href=\"UTD.htm?16/51/17210\"
    title=\"figure 4\">",
    " Veins of leg and foot",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <div class=\"openRelatedGraphics\" id=\"EM/13824|PIC\">",
    " <a href=\"#\" title=\"PICTURES\">",
    " PICTURES",
    " </a>",
    " </div>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?23/12/23751\"
    title=\"picture 1\">",
    " Peripheral IV catheters",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?34/25/35217\"
    title=\"picture 2\">",
    " Peripheral IV placement 2",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?31/55/32624\"
    title=\"picture 3\">",
    " Peripheral IV placement 3",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?10/3/10289\"
    title=\"picture 4\">",
    " Peripheral IV placement 4",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?3/45/3793\"
    title=\"picture 5\">",
    " Peripheral IV placement 5",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?16/13/16592\"
    title=\"picture 6\">",
    " Peripheral IV placement 6",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?36/28/37315\"
    title=\"picture 7\">",
    " Peripheral IV placement 7",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_picture\" href=\"UTD.htm?31/63/32752\"
    title=\"picture 8\">",
    " Peripheral IV placement 8",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " RELATED TOPICS",
    " </h1>",
    " <div id=\"relatedTopics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?25/22/25962?
    source=related_link\">",
    " Assessment and management of the acutely agitated or violent adult",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?26/26/27050?
    source=related_link\">",
    " Catheter-induced upper extremity venous thrombosis",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?0/1/29?
    source=related_link\">",
    " Complications of central venous catheters and their prevention",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/11/35002?
    source=related_link\">",
    " Initial management of trauma in adults",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?39/51/40761?
    source=related_link\">",
    " Intraosseous infusion",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?43/32/44553?
    source=related_link\">",
    " Overview of central venous access",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?35/11/36024?
    source=related_link\">",
    " Placement of femoral venous catheters",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?3/14/3306?
    source=related_link\">",
    " Placement of jugular venous catheters",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?1/27/1466?
    source=related_link\">",
    " Placement of subclavian venous catheters",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?30/53/31578?
    source=related_link\">",
    " Prevention of intravascular catheter-related infections",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?3/47/3833?
    source=related_link\">",
    " Principles of ultrasound-guided venous access",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?42/25/43417?
    source=related_link\">",
    " Superficial thrombophlebitis of the lower extremity",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?42/50/43817?
    source=related_link\">",
    " Topical anesthetics in children",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?7/55/8057?
    source=related_link\">",
    " Vascular (venous) access for pediatric resuscitation and other pediatric
    emergencies",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " </div>"].join("\n");
    var title_f6_13_6362="Selection of initial therapy for symptomatic or advanced
    chronic lymphocytic leukemia";
    var content_f6_13_6362=[" <noscript>",
    " <div id=\"javascriptDisabled\">",
    " It seems to us that you have your JavaScript turned off on your browser.
    JavaScript is required in order for our site to behave correctly. Please enable
    your JavaScript to continue use our site.",
    " </div>",
    " </noscript>",
    " <div id=\"printHeader\">",
    " <div id=\"printHeaderLogo\">",
    " <img alt=\"UpToDate\" src=\"./../images/UTD2_masthead.myextg\">",
    " <img align=\"right\" alt=\"Wolters Kluwer Health\" height=\"40\"
    src=\"./../images/logoWKH.myextg\" width=\"175\">",
    " <br>",
    " <div id=\"printHeaderText\">",
    " Official reprint from UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " <br>",
    " <a href=\"file://www.uptodate.com\">",
    " www.uptodate.com",
    " </a>",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </br>",
    " </div>",
    " </br>",
    " </img>",
    " </img>",
    " </div>",
    " <div id=\"printHeaderLinks\">",
    " <a class=\"TOPIC\" href=\"#\" id=\"printHeaderPrint\" rel=\"6\" title=\"Click
    here to print\">",
    " Print",
    " </a>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a href=\"#\" id=\"printHeaderBack\" title=\"Back to normal view\">",
    " Back",
    " </a>",
    " </div>",
    " </div>",
    " <!-- TC:TOPIC_PAGE -->",
    " <div id=\"topicContent\">",
    " <div id=\"topicTitle\">",
    " Selection of initial therapy for symptomatic or advanced chronic lymphocytic
    leukemia",
    " </div>",
    " <div id=\"topicContributors\">",
    " <div>",
    " <a id=\"authors\">",
    " </a>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6362/contributors\">",
    " Authors",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6362/contributors\">",
    " Kanti R Rai, MD",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6362/contributors\">",
    " Michael J Keating, MD",
    " </a>",
    " <br/>",
    " </div>",
    " <div>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6362/contributors\">",
    " Section Editor",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6362/contributors\">",
    " Richard A Larson, MD",
    " </a>",
    " <br/>",
    " </div>",
    " <div>",
    " <a class=\"contributor contributor_credentials contributorType\"
    href=\"UTD.htm?6/13/6362/contributors\">",
    " Deputy Editor",
    " </a>",
    " <br/>",
    " <a class=\"contributor contributor_credentials\" href=\"UTD.htm?
    6/13/6362/contributors\">",
    " Rebecca F Connor, MD",
    " </a>",
    " <br/>",
    " </div>",
    " </div>",
    " <div id=\"disclosures\">",
    " <a href=\"UTD.htm?6/13/6362/contributor-disclosure\" target=\"_blank\">",
    " Disclosures",
    " </a>",
    " </div>",
    " <div id=\"reviewProcess\">",
    " <span>",
    " All topics are updated as new evidence becomes available and our",
    " </span>",
    " <a href=\"/home/editorial-policy\" target=\"_blank\">",
    " peer review process",
    " </a>",
    " <span>",
    " is complete.",
    " </span>",
    " </div>",
    " <div id=\"literatureReviewDate\">",
    " <span class=\"emphasis\">",
    " Literature review current through:",
    " </span>",
    " Oct 2013.",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <span class=\"emphasis\">",
    " This topic last updated:",
    " </span>",
    " Mar 22, 2013.",
    " </div>",
    " <div id=\"topicText\">",
    " <p class=\"headingAnchor\" id=\"H5623314\">",
    " <span class=\"h1\">",
    " INTRODUCTION",
    " </span>",
    " &nbsp;&mdash;&nbsp;Chronic lymphocytic leukemia (CLL) is one of the chronic
    lymphoproliferative disorders (lymphoid neoplasms). It is characterized by a
    progressive accumulation of functionally incompetent lymphocytes, which are
    monoclonal in origin.",
    " </p>",
    " <p>",
    " CLL is considered to be identical (ie, one disease at different stages) to the
    mature (peripheral) B cell neoplasm small lymphocytic lymphoma (SLL), one of the
    indolent non-Hodgkin lymphomas. The term CLL is used when the disease manifests
    primarily in the bone marrow and blood, whereas the term SLL is used when
    involvement is primarily nodal. While there is some difference to the treatment of
    early stage CLL and SLL, the treatment of advanced stage disease is the same.
    (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/38/35431?
    source=see_link\">",
    " \"Pathologic features, diagnosis, and differential diagnosis of chronic
    lymphocytic leukemia\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " The selection of initial therapy for advanced stage or symptomatic disease
    will be reviewed here. General issues regarding the treatment of",
    " <span class=\"nowrap\">",
    " CLL/SLL,",
    " </span>",
    " the treatment of",
    " <span class=\"nowrap\">",
    " relapsed/refractory",
    " </span>",
    " CLL, the use of hematopoietic cell transplantation in CLL, and the management
    of complications of CLL and its treatment are discussed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?28/42/29352?
    source=see_link\">",
    " \"Overview of the treatment of chronic lymphocytic leukemia\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/12/35017?
    source=see_link\">",
    " \"Overview of the complications of chronic lymphocytic leukemia\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?29/46/30442?
    source=see_link\">",
    " \"Treatment of relapsed or refractory chronic lymphocytic leukemia\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/61/35800?
    source=see_link\">",
    " \"Hematopoietic cell transplantation in chronic lymphocytic leukemia\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " The pathophysiology, clinical manifestations, diagnosis, staging, and
    prognosis of CLL and SLL are also discussed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?24/6/24680?
    source=see_link\">",
    " \"Epidemiology and clinical manifestations of chronic lymphocytic
    leukemia\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/38/35431?
    source=see_link\">",
    " \"Pathologic features, diagnosis, and differential diagnosis of chronic
    lymphocytic leukemia\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?15/6/15466?
    source=see_link\">",
    " \"Staging and prognosis of chronic lymphocytic leukemia\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?41/23/42361?
    source=see_link\">",
    " \"Pathophysiology and genetic features of chronic lymphocytic leukemia\"",
    " </a>",
    " .)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5622415\">",
    " <span class=\"h1\">",
    " INITIAL THERAPY",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H1664568\">",
    " <span class=\"h2\">",
    " Our general approach",
    " </span>",
    " &nbsp;&mdash;&nbsp;There is no agreed upon standard treatment regimen for
    symptomatic CLL or advanced SLL. Experts in the field use different treatment
    approaches. As such, there are several initial treatment options for patients with
    symptomatic CLL or advanced SLL. These include purine analogs (eg,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?39/9/40086?source=see_link\">",
    " pentostatin",
    " </a>",
    " ), alkylating agents (eg,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/20/32071?source=see_link\">",
    " bendamustine",
    " </a>",
    " ), monoclonal antibodies (eg,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/13/35029?source=see_link\">",
    " ofatumumab",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " ), or combinations of these agents. The optimal therapy for each of the
    subpopulations of CLL patients (eg, young, elderly, or patients with high-risk
    features) is not currently known, and is the subject of multiple ongoing
    cooperative studies. The best treatment for an individual patient may be enrollment
    in a well-conducted clinical trial. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?29/46/30442?
    source=see_link&amp;anchor=H15#H15\">",
    " \"Treatment of relapsed or refractory chronic lymphocytic leukemia\", section
    on 'Investigational therapies'",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Most of the treatment options have not been directly compared. When
    prospective randomized trials have been performed, most regimens have been compared
    with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " , an alkylating agent that had been a standard of care for decades prior to
    the advent of newer agents (eg, monoclonal antibodies, purine analogs). The
    estimated median overall survival with modern regimens is approximately five years.
    While overall survival rates are similar, these regimens differ in their rates of
    complete remission (CR), time to progression, and associated toxicities. For
    patients who do not wish to participate in a clinical trial, our choice among these
    therapies is made based upon patient characteristics, tumor characteristics, and
    goals of therapy:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " For most younger (&lt;70 years) patients, we prefer the use of a regimen
    that contains both",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " . Specifically, we use combination therapy with either fludarabine,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " , and rituximab (FCR) (",
    " <a class=\"graphic graphic_table graphicRef86797 \" href=\"UTD.htm?
    22/3/22590\">",
    " table 1",
    " </a>",
    " ) or fludarabine plus rituximab (FR) (",
    " <a class=\"graphic graphic_table graphicRef86798 \" href=\"UTD.htm?
    1/32/1550\">",
    " table 2",
    " </a>",
    " ). As described in more detail below, studies suggest that regimens that
    include these agents improve survival in this patient population. (See",
    " <a class=\"local\" href=\"#H23868573\">",
    " 'Choice of fludarabine regimen'",
    " </a>",
    " below.)",
    " </li>",
    " <li>",
    " For most older adults (&gt;70 years) with CLL, we prefer initial treatment
    with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?
    source=see_link\">",
    " chlorambucil",
    " </a>",
    " . While",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapy results in superior response rates, it does not appear to
    improve survival in this population. In addition, older patients who have a
    compromised performance status may have a higher incidence of opportunistic
    infections with fludarabine-based therapy. Fludarabine may also lead to prolonged
    myelosuppression in this age group. (See",
    " <a class=\"local\" href=\"#H5624031\">",
    " 'Older adults'",
    " </a>",
    " below.)",
    " </li>",
    " <li>",
    " Patients with del(17p) or del(11q) are at high risk of either not responding
    to initial treatment, or relapsing soon after achieving remission and should be
    encouraged to participate in clinical trials. For these patients, we prefer initial
    treatment with FCR, followed by",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " . Younger patients with an HLA-matched related or matched unrelated donor
    are considered for non-myeloablative allogeneic hematopoietic cell transplantation.
    (See",
    " <a class=\"local\" href=\"#H5624038\">",
    " 'High-risk disease: del(17p) or del(11q)'",
    " </a>",
    " below.)",
    " </li>",
    " </ul>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5622422\">",
    " <span class=\"h2\">",
    " Fludarabine-based therapy",
    " </span>",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H23868573\">",
    " <span class=\"h3\">",
    " Choice of fludarabine regimen",
    " </span>",
    " &nbsp;&mdash;&nbsp;Our preferred first line therapy for most patients with CLL
    is combination therapy that includes",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " . Long-term toxicity with fludarabine-based regimens appears to be limited to
    myelotoxicity and infectious complications [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/1\">",
    " 1",
    " </a>",
    " ]. The use of fludarabine also increases the rate of development of autoimmune
    hemolytic anemia. The addition of rituximab to initial therapy has been associated
    with improved survival in younger patients with CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/2,3\">",
    " 2,3",
    " </a>",
    " ]. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?0/25/410?
    source=see_link\">",
    " \"Overview of infectious complications following purine analog therapy\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?8/29/8665?
    source=see_link\">",
    " \"Autoimmune complications following purine analog therapy\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Options include:",
    " </p>",
    " <p>",
    " <ul class=\"bulletCompact-block\">",
    " <li>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " Fludarabine",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " , and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " (FCR) (",
    " <a class=\"graphic graphic_table graphicRef86797 \" href=\"UTD.htm?
    22/3/22590\">",
    " table 1",
    " </a>",
    " )",
    " </li>",
    " <li>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " Fludarabine",
    " </a>",
    " plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " (FR) (",
    " <a class=\"graphic graphic_table graphicRef86798 \" href=\"UTD.htm?
    1/32/1550\">",
    " table 2",
    " </a>",
    " )",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " A randomized trial comparing FCR and FR is underway in the US intergroup
    (CALGB 10404). In phase II trials, overall survival rates appear to be similar with
    these regimens, but toxicity is lower with FR. FCR appears to result in higher
    complete remission rates (70 versus 47 percent), but similar overall response rates
    (95 versus 90 percent). The combination of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " , and the human CD20 monoclonal antibody",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/13/35029?source=see_link\">",
    " ofatumumab",
    " </a>",
    " (O-FC) has demonstrated activity in previously untreated CLL, but long-term
    results with this regimen and comparative trials are unavailable [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/4\">",
    " 4",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " FCR appears to be superior to",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " (FC). An open-label, phase III randomized trial compared six courses of FCR
    with six courses of FC in 817 previously untreated patients with CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/5,6\">",
    " 5,6",
    " </a>",
    " ]. FCR resulted in the following statistically significant findings [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/6\">",
    " 6",
    " </a>",
    " ]:",
    " </p>",
    " <p>",
    " <ul class=\"bulletCompact-block\">",
    " <li>",
    " Higher rates of overall (95 versus 88 percent) and complete (44 versus 22
    percent) response",
    " </li>",
    " <li>",
    " Longer median progression-free survival (52 versus 33 months)",
    " </li>",
    " <li>",
    " Better overall survival at three years (87 versus 83 percent)",
    " </li>",
    " <li>",
    " Higher rates of severe (grade",
    " <span class=\"nowrap\">",
    " 3/4)",
    " </span>",
    " neutropenia (34 versus 21 percent), leukocytopenia (24 versus 12 percent)",
    " </li>",
    " <li>",
    " Similar rates of treatment-related deaths (2 versus 3 percent)",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " Fludarabine",
    " </a>",
    " -based therapy has also demonstrated superiority to",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " in younger adults. Several prospective, randomized trials comparing single
    agent purine analogs (eg, fludarabine) to alkylating agents (eg, chlorambucil)
    demonstrated improved response rates and progression-free survival for patients
    treated with purine analogs [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/7\">",
    " 7",
    " </a>",
    " ]. While initial reports demonstrated similar survival rates, long-term
    follow-up of a randomized phase III trial comparing fludarabine, chlorambucil, or a
    combination of the two in 509 previously untreated patients with CLL demonstrated
    that, when compared with chlorambucil alone, single agent fludarabine results in
    significantly higher overall survival rates at six years (43 versus 38 percent) and
    at eight years (31 versus 19 percent) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/8\">",
    " 8",
    " </a>",
    " ]. A separate analysis of 663 patients enrolled onto successive trials of
    initial therapy in CLL confirmed a survival benefit for fludarabine compared with
    chlorambucil among patients younger than 70 years (hazard ratio [HR] 0.7, 95% CI
    0.5-0.9), but not in those over 70 years (HR 1.0, 95% CI 0.6-1.7) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/2\">",
    " 2",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " These data from long-term analyses show that the drug chosen for the initial
    treatment can be important and may manifest its survival benefit over another drug
    only several years later. In addition, they demonstrate the importance of patient
    characteristics (eg, age) on the choice of therapy. (See",
    " <a class=\"local\" href=\"#H5624031\">",
    " 'Older adults'",
    " </a>",
    " below.)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5622436\">",
    " <span class=\"h3\">",
    " Fludarabine, cyclophosphamide, and rituximab",
    " </span>",
    " &nbsp;&mdash;&nbsp;FCR is our preferred treatment option for younger patients
    (&lt;70 years) with standard risk CLL. Several nonrandomized phase II trials have
    evaluated",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " in combination with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " (FCR) in previously untreated patients [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/9-14\">",
    " 9-14",
    " </a>",
    " ]. In addition, the randomized trial described above demonstrated superior
    survival rates with FCR when compared with fludarabine plus cyclophosphamide [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/6\">",
    " 6",
    " </a>",
    " ]. The FCR regimen has been administered in different variations (",
    " <a class=\"graphic graphic_table graphicRef86797 \" href=\"UTD.htm?
    22/3/22590\">",
    " table 1",
    " </a>",
    " ). (See",
    " <a class=\"local\" href=\"#H5622422\">",
    " 'Fludarabine-based therapy'",
    " </a>",
    " above.)",
    " </p>",
    " <p>",
    " Overall response and CR rates with FCR are approximately 95 and 70 percent,
    respectively. At the time the largest of these studies were performed, CR did not
    require negative flow cytometry of the peripheral blood. However, most patients
    with CR had no detectable disease on flow cytometry at the end of therapy
    suggesting a potentially deeper response. The estimated four-year failure-free
    survival is 69 percent [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/9,10\">",
    " 9,10",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " Six-year follow-up is available for 300 patients initially treated with FCR
    combination therapy as part of one of these prospective phase II trials [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/15\">",
    " 15",
    " </a>",
    " ]. Six-year overall and failure-free survival rates were 77 and 51 percent,
    respectively, and the median time to progression was 80 months. The risk of late
    infection for the first and second years were 10 and 4 percent with rates of
    &lt;1.5 percent per year for subsequent years.",
    " </p>",
    " <p>",
    " Treatment-related mortality was less than 1 percent. The first dose of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " was associated with infusional symptoms (fever, chills, hypotension, dyspnea,
    nausea, or vomiting) that were usually mild and responded to",
    " <a class=\"drug drug_general\" href=\"UTD.htm?11/44/11976?source=see_link\">",
    " meperidine",
    " </a>",
    " or",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/49/32528?source=see_link\">",
    " hydrocortisone",
    " </a>",
    " therapy. Subsequent infusions of rituximab were usually uneventful. Additional
    toxicities with FCR included cytopenias, infections, nausea (23 percent), vomiting
    (7 percent), and hair loss. Severe (grade",
    " <span class=\"nowrap\">",
    " 3/4)",
    " </span>",
    " neutropenia occurred in 52 percent, but major or minor infections occurred in
    only 2.6 and 10 percent of cycles, respectively.",
    " </p>",
    " <p>",
    " Less common side effects of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " can include hemorrhagic cystitis, bladder carcinogenesis, impairment of
    fertility, leukemogenesis, and, with prolonged high dose therapy, interstitial
    pulmonary fibrosis. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?24/32/25098?
    source=see_link\">",
    " \"General toxicity of cyclophosphamide and chlorambucil in inflammatory
    diseases\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Limited data are available for a regimen that adds",
    " <a class=\"drug drug_general\" href=\"UTD.htm?36/31/37368?source=see_link\">",
    " mitoxantrone",
    " </a>",
    " to the FCR combination (R-FCM). A phase II trial of R-FCM followed by",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " maintenance in 72 previously untreated patients with CLL reported overall and
    complete response rates of 93 and 46 percent, respectively [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/16\">",
    " 16",
    " </a>",
    " ]. We await longer follow-up and additional reports confirming these results
    prior to incorporating this regimen into our initial therapy of patients with
    CLL.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H23868398\">",
    " <span class=\"h3\">",
    " Fludarabine plus rituximab",
    " </span>",
    " &nbsp;&mdash;&nbsp;",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " Fludarabine",
    " </a>",
    " plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " (FR) is an acceptable alternative to FCR as the initial treatment of younger
    adults (&lt;70 years) with standard risk CLL. FR has been studied both
    prospectively in varying dosing schedules and retrospectively compared with
    fludarabine treatment alone. Concurrent administration results in higher response
    rates and moderately higher toxicity when compared with sequential therapy. The
    concurrent administration of fludarabine plus rituximab results in overall response
    and CR rates of approximately 90 and 47 percent, respectively. The administration
    of FR to patients with CLL can be complicated by infusion-related reactions and
    tumor lysis syndrome. Several variations on administration dose and schedule have
    been used (",
    " <a class=\"graphic graphic_table graphicRef86798 \" href=\"UTD.htm?
    1/32/1550\">",
    " table 2",
    " </a>",
    " ).",
    " </p>",
    " <p>",
    " A randomized phase II trial evaluated concurrent or sequential FR in 104
    symptomatic, previously untreated patients with CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/17\">",
    " 17",
    " </a>",
    " ]. The concurrent arm received induction with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " in six 28-day cycles followed by consolidation rituximab for responders. The
    sequential arm received induction with fludarabine alone in six 28-day cycles
    followed by consolidation rituximab for responders. Although the treatment was
    randomly assigned, the study was not designed for the direct comparison of response
    rates in the two arms. Overall response rates for the concurrent and sequential
    treatment arms were 90 percent (47 percent CR) and 77 percent (28 percent CR),
    respectively. At a median follow-up of 117 months, the median overall survival was
    85 months with a five-year survival rate of 71 percent [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/18\">",
    " 18",
    " </a>",
    " ]. The median progression-free survival (PFS) was 42 months with a five-year
    PFS rate of 27 percent. The estimated PFS at 10 years was 13 percent.",
    " </p>",
    " <p>",
    " Neutropenia and infusion-related toxicities were more common in patients
    receiving concurrent therapy [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/17\">",
    " 17",
    " </a>",
    " ]. Patients treated with concurrent FR had a significantly higher rate of
    severe neutropenia (76 versus 39 percent) when compared with patients who received
    sequential therapy, but a similar rate of severe infection (approximately 20
    percent). Infusion-related toxicity was usually mild and was seen in all patients
    given concordant",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " . After a median follow-up of 117 months, no patient developed therapy-related
    myelodysplastic syndrome (t-MDS) or acute myeloid leukemia while in remission
    following FR alone [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/18\">",
    " 18",
    " </a>",
    " ]. One patient who received",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " , and rituximab (FCR) for the treatment of relapsed CLL later developed t-MDS.
    Four patients underwent Richter&rsquo;s transformation to a more aggressive
    lymphoma.",
    " </p>",
    " <p>",
    " A retrospective analysis comparing treatment with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " alone (fludarabine arm, CALGB 9011) to treatment with fludarabine plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " (CALGB 9712) indicated better progression-free and overall survival rates with
    the two-drug combination, with similar infectious complications [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/19\">",
    " 19",
    " </a>",
    " ].",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H23868301\">",
    " <span class=\"h2\">",
    " Bendamustine-based therapy",
    " </span>",
    " &nbsp;&mdash;&nbsp;",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/20/32071?source=see_link\">",
    " Bendamustine",
    " </a>",
    " has received approval from the US Food and Drug Administration for both
    previously untreated as well as relapsed CLL. Bendamustine has demonstrated
    superior response rates when compared with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " . However, a survival benefit has not been demonstrated. Single arm studies
    have demonstrated higher response rates when bendamustine is administered in
    combination with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " (BR). This BR regimen is preferred to single agent bendamustine based upon
    analyses that have demonstrated superior survival when rituximab is added to",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapy in CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/2\">",
    " 2",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " A large, multi-institutional randomized clinical study demonstrated superior
    response rates with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/20/32071?source=see_link\">",
    " bendamustine",
    " </a>",
    " when compared with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " therapy. In this trial of 319 patients with previously untreated and
    symptomatic CLL, treatment was randomly assigned either with chlorambucil or with
    bendamustine for up to six cycles [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/20\">",
    " 20",
    " </a>",
    " ]. Bendamustine was given at a dose of 100",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " IV over 30 minutes on days 1 and 2 of a 28-day cycle. The trial excluded
    patients with autoimmune hemolytic anemia, autoimmune thrombocytopenia, Richter's
    syndrome, or transformation to prolymphocytic leukemia. Patients who were treated
    with bendamustine had significantly higher rates of overall response (68 versus 31
    percent) and longer median progression-free survival (21.6 versus 8.3 months) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/21\">",
    " 21",
    " </a>",
    " ]. Overall survival data show no difference between these two arms, but
    require longer follow-up. Patients assigned to therapy with bendamustine had a
    trend towards more severe (grade",
    " <span class=\"nowrap\">",
    " 3/4)",
    " </span>",
    " toxicities including: neutropenia (23 versus 10 percent), thrombocytopenia (12
    versus 8 percent), and anemia (3 versus zero percent). In addition, bendamustine
    use was associated with hypersensitivity reactions (5 versus 2 percent) and
    gastrointestinal toxicities requiring more frequent use of antiemetics (36 versus 4
    percent).",
    " </p>",
    " <p>",
    " The BR regimen was evaluated in a single arm trial of 117 patients (age 34 to
    78 years) with previously untreated CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/22\">",
    " 22",
    " </a>",
    " ]. The regimen consisted of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/20/32071?source=see_link\">",
    " bendamustine",
    " </a>",
    " 90",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " on days 1 and 2 and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " 375",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " on day 0 of the first course and 500",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " on day 1 of subsequent courses. Patients received up to six courses. The
    overall and complete response rates were 88 and 23 percent, respectively, and
    included patients with high risk disease. After a median follow-up of 27 months,
    the median event-free survival was 34 months. Severe (grade",
    " <span class=\"nowrap\">",
    " 3/4)",
    " </span>",
    " toxicities included neutropenia (20 percent), thrombocytopenia (22 percent),
    anemia (20 percent), and infections (8 percent).",
    " </p>",
    " <p>",
    " An ongoing large prospective randomized trial is comparing FCR with BR as
    initial therapy for patients with previously untreated CLL.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H23868177\">",
    " <span class=\"h2\">",
    " Pentostatin-based therapy",
    " </span>",
    " &nbsp;&mdash;&nbsp;",
    " <a class=\"drug drug_general\" href=\"UTD.htm?39/9/40086?source=see_link\">",
    " Pentostatin",
    " </a>",
    " is a purine analog that has been used for the treatment of CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/23-28\">",
    " 23-28",
    " </a>",
    " ]. Combination therapy is preferred to single agent therapy because it results
    in superior complete response rates and treatment-free survival rates in phase II
    trials.",
    " </p>",
    " <p>",
    " The most commonly used",
    " <a class=\"drug drug_general\" href=\"UTD.htm?39/9/40086?source=see_link\">",
    " pentostatin",
    " </a>",
    " -based regimens consist of pentostatin (2 to 4",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " ),",
    " </span>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " (600",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " ),",
    " </span>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " (375",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " )",
    " </span>",
    " given intravenously in 21-day cycles (PCR) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/23,24\">",
    " 23,24",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " A phase II trial in 64 patients (median age 63 years) with previously
    untreated symptomatic CLL evaluated the use of PCR every 21 days for six planned
    cycles with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?23/13/23767?source=see_link\">",
    " granulocyte colony-stimulating factor",
    " </a>",
    " (G-CSF) support [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/23\">",
    " 23",
    " </a>",
    " ]. Overall and complete response rates were 91 and 41 percent, respectively.
    The rates of severe (grade 3 or higher) hematologic and nonhematologic toxicity
    were 52 and 34 percent, respectively. The most common nonhematologic toxicities
    were infection (9 percent), nausea (9 percent), vomiting (6 percent), and fever (6
    percent). There were two deaths during treatment.",
    " </p>",
    " <p>",
    " Some clinicians prefer",
    " <a class=\"drug drug_general\" href=\"UTD.htm?39/9/40086?source=see_link\">",
    " pentostatin",
    " </a>",
    " -based therapy for its ease of administration and initial reports of less
    myelosuppression when compared with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapy. However, many of the prospective trials of pentostatin-based
    regimens have included the use of hematopoietic growth factors for all patients.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H23869242\">",
    " <span class=\"h2\">",
    " Alemtuzumab",
    " </span>",
    " &nbsp;&mdash;&nbsp;Front-line therapy with the anti-CD52 antibody",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " has demonstrated superior response rates when compared with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " . However, a survival benefit has not been demonstrated. The manufacturer of
    alemtuzumab withdrew this product from the US market in September 2012. These
    actions were not related to safety concerns, but instead were to prepare for the
    planned marketing of this drug under a different name for other conditions.
    Alemtuzumab remains accessible through a distribution program for the treatment of
    CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/29\">",
    " 29",
    " </a>",
    " ]. For most patients with previously untreated CLL, we prefer",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapy to alemtuzumab except in the initial treatment of patients with
    chromosome 17p deletion. (See",
    " <a class=\"local\" href=\"#H5624038\">",
    " 'High-risk disease: del(17p) or del(11q)'",
    " </a>",
    " below.)",
    " </p>",
    " <p>",
    " Single agent",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " results in overall response and complete remission (CR) rates of approximately
    83 and 24 percent, respectively. Alemtuzumab has been least effective in patients
    with bulky lymphadenopathy [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/30-33\">",
    " 30-33",
    " </a>",
    " ]. As an example, a study in previously treated patients found that overall
    response rates with alemtuzumab varied greatly depending upon the size of enlarged
    nodes [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/33\">",
    " 33",
    " </a>",
    " ]. Overall response rates were 87, 40, and 9 percent in patients with no
    lymphadenopathy, those whose largest node was &le;5 cm, and those whose largest
    node was &gt;5 cm, respectively. Common toxicities of alemtuzumab include
    neutropenia, infections, and infusion reactions.",
    " </p>",
    " <p>",
    " A prospective phase III trial of 297 previously untreated, symptomatic
    patients with Rai stage I-IV CLL randomly assigned treatment with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " (30 mg IV over two hours three",
    " <span class=\"nowrap\">",
    " times/week",
    " </span>",
    " on alternate days for a maximum of 12 weeks) or",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " (40",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " PO once every 28 days for a maximum of 12 months) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/34\">",
    " 34",
    " </a>",
    " ]. Most patients (77 percent) had maximum lymph nodes &lt;5 cm in diameter.
    World Health Organization performance status was zero or one in 96 percent.",
    " </p>",
    " <p>",
    " All patients receiving",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " were given prophylactic antibiotics (",
    " <a class=\"drug drug_general\" href=\"UTD.htm?4/58/5034?source=see_link\">",
    " trimethoprim-sulfamethoxazole",
    " </a>",
    " DS) and antiviral agents (",
    " <a class=\"drug drug_general\" href=\"UTD.htm?36/23/37238?source=see_link\">",
    " famciclovir",
    " </a>",
    " ) during therapy and until CD4+ cell counts were",
    " <span class=\"nowrap\">",
    " &ge;200/microL",
    " </span>",
    " and for a minimum of two months after last treatment.",
    " </p>",
    " <p>",
    " At a median follow-up of 25 months, patients treated with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " had the following significantly better outcomes when compared with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " :",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Higher overall response (83 versus 55 percent) and complete remission (24
    versus 2 percent) rates",
    " </li>",
    " <li>",
    " Longer progression-free survival (15 versus 12 months) and time to
    alternative treatment (23 versus 15 months)",
    " </li>",
    " <li>",
    " Higher response rate in patients with 17p deletion (64 versus 20 percent),
    as noted in a subset analysis",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " The study was not powered to find a difference in overall survival.",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " Alemtuzumab",
    " </a>",
    " therapy was associated with higher rates of the following toxicities:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Neutropenia (41 versus 25 percent). The rates of febrile neutropenia (5
    versus 3 percent) and",
    " <span class=\"nowrap\">",
    " bacteremia/sepsis",
    " </span>",
    " (3 versus 1.5 percent) were similar.",
    " </li>",
    " <li>",
    " Symptomatic CMV infections (16 versus zero percent) and CMV viremia (56
    versus 8 percent).",
    " </li>",
    " <li>",
    " Infusion reaction that included fevers (69 percent), chills (53 percent),
    nausea (18 percent), hypotension (16 percent), urticaria (16 percent), headache (14
    percent), dyspnea (14 percent), and vomiting (11 percent). Less common infusion
    reactions included tachycardia, anxiety, pruritus, tremor, and bronchospasm. These
    side effects appear to be less when",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " is administered subcutaneously [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/35\">",
    " 35",
    " </a>",
    " ].",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " While the concurrent administration of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " plus a",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based combination has been associated with high response rates, wide
    application of these combinations is limited by unacceptably high rates of toxicity
    [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/36,37\">",
    " 36,37",
    " </a>",
    " ]. The use of alemtuzumab consolidation following initial treatment with a
    fludarabine-based combination may be better tolerated, but the efficacy and the
    best scheduling remain to be determined. (See",
    " <a class=\"local\" href=\"#H5624038\">",
    " 'High-risk disease: del(17p) or del(11q)'",
    " </a>",
    " below.)",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5624009\">",
    " <span class=\"h1\">",
    " SPECIAL PATIENT POPULATIONS",
    " </span>",
    " &nbsp;&mdash;&nbsp;While most patients with symptomatic or advanced stage CLL
    are treated similarly, older patients and patients with del(17p) or del(11q)
    require particular consideration.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5624031\">",
    " <span class=\"h2\">",
    " Older adults",
    " </span>",
    " &nbsp;&mdash;&nbsp;Clinicians often have concerns about the ability of older
    adults (ie, over age 70 years) to tolerate chemotherapy. The management of CLL in
    older adults can be complicated by an increased number of comorbidities. A
    comprehensive geriatric assessment may be useful in assessing comorbidity and
    functional status in such patients, thereby permitting the formulation of an
    appropriate, individualized treatment plan. Special considerations for the use of
    chemotherapy in older adults are discussed separately. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/56/41864?
    source=see_link\">",
    " \"Comprehensive geriatric assessment for patients with cancer\"",
    " </a>",
    " and",
    " <a class=\"medical medical_review\" href=\"UTD.htm?10/42/10922?
    source=see_link\">",
    " \"Systemic chemotherapy for cancer in elderly persons\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " Treatment options for older adults with CLL who might have varying levels of
    co-morbidities and compromised performance status, in order of increasing response
    rates and increasing toxicity, include:",
    " </p>",
    " <p>",
    " <ul class=\"bulletCompact-block\">",
    " <li>",
    " Pulsed intermittent single agent",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?
    source=see_link\">",
    " chlorambucil",
    " </a>",
    " (eg, a single oral dose of 0.8",
    " <span class=\"nowrap\">",
    " mg/kg",
    " </span>",
    " every four weeks, adjusted as needed)",
    " </li>",
    " <li>",
    " Lower dose",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " (25",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " IV for three consecutive days every month)",
    " </li>",
    " <li>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " Fludarabine",
    " </a>",
    " plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " (FR) (",
    " <a class=\"graphic graphic_table graphicRef86798 \" href=\"UTD.htm?
    1/32/1550\">",
    " table 2",
    " </a>",
    " )",
    " </li>",
    " <li>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " Fludarabine",
    " </a>",
    " ,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " , and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " (FCR) (",
    " <a class=\"graphic graphic_table graphicRef86797 \" href=\"UTD.htm?
    22/3/22590\">",
    " table 1",
    " </a>",
    " )",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " For older adults with CLL, we prefer initial treatment with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " . This preference is based upon the better tolerability of chlorambucil and
    similar survival rates when compared with other agents in this population.",
    " </p>",
    " <p>",
    " A phase III trial included 193 older adults (median age 70) with an adequate
    performance status (Eastern Cooperative Oncology Group 2 or better), and
    symptomatic, previously untreated CLL who were randomly assigned to single agent
    treatment with either",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " or",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/38\">",
    " 38",
    " </a>",
    " ]. After a median follow-up of 42 months, patients assigned to chlorambucil
    had the following outcomes when compared with those assigned to fludarabine:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Significantly lower rates of overall (51 versus 72 percent) and complete
    (zero versus 7 percent) response.",
    " </li>",
    " <li>",
    " Similar rates of progression-free survival (18 versus 19 months), a
    nonsignificant trend toward longer overall survival with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?
    source=see_link\">",
    " chlorambucil",
    " </a>",
    " (64 versus 46 months), and a significantly higher proportion of patients who
    were retreated with either chlorambucil or",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " for disease progression (77 versus 50 percent).",
    " </li>",
    " <li>",
    " Lower rates of severe (grade",
    " <span class=\"nowrap\">",
    " 3/4)",
    " </span>",
    " myelotoxicity (23 versus 42 percent), but similar rates of severe infection
    (4 versus 8 percent) and all infections (32 versus 26 percent).",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " Similarly, an analysis of 663 patients enrolled onto successive trials of
    initial therapy in CLL demonstrated a survival benefit for",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " compared with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " among patients younger than 70 years (hazard ratio [HR] 0.7, 95% CI 0.5 to
    0.9), but not in those over 70 years (HR 1.0, 95% CI 0.6 to 1.7) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/2\">",
    " 2",
    " </a>",
    " ]. Together, these studies suggest that the outcomes after initial therapy
    differ with age. While fludarabine-based therapy results in superior response
    rates, a survival benefit compared to single agent chlorambucil therapy has yet to
    be confirmed in this older population.",
    " </p>",
    " <p>",
    " We give",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?source=see_link\">",
    " chlorambucil",
    " </a>",
    " in a pulsed intermittent dose schedule (eg, a single oral dose of 0.8",
    " <span class=\"nowrap\">",
    " mg/kg",
    " </span>",
    " every four weeks). The chlorambucil dose is modified based upon laboratory
    studies to prevent the development of significant anemia, neutropenia,",
    " <span class=\"nowrap\">",
    " and/or",
    " </span>",
    " thrombocytopenia, which are the main toxicities associated with its use [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/39\">",
    " 39",
    " </a>",
    " ]. Other less common adverse effects of chlorambucil include infertility,
    seizures, hepatotoxicity, hypersensitivity, drug fever, pulmonary fibrosis, and
    interstitial pneumonia.",
    " </p>",
    " <p>",
    " An acceptable alternative for older adults with a good performance status
    (ECOG &le;2) is treatment with FR or FCR. This option may be preferred by those who
    are willing to accept the increased toxicity associated with these regimens and
    place a high value on the potential for a deeper response. The median age at
    diagnosis of CLL is 70 years, and many of the prospective trials described above
    that have evaluated",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapy have included older patients with a good performance status.
    Fludarabine-based combination chemotherapy regimens can be delivered safely to
    older patients who have a good performance status with modestly increased
    myelosuppression but no increase in severe infectious complications or treatment-
    related mortality [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/40\">",
    " 40",
    " </a>",
    " ]. Cumulative myelosuppression has been noted with FCR, and older patients, in
    particular, may not be able to tolerate six courses. A regimen labeled &ldquo;FCR-
    lite&rdquo; has been described, which has a higher dose of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " , but somewhat lower doses of fludarabine and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/11\">",
    " 11",
    " </a>",
    " ]. We do not advocate the use of this regimen until further data are obtained
    comparing it with other available treatments.",
    " </p>",
    " <p>",
    " The addition of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?source=see_link\">",
    " rituximab",
    " </a>",
    " to initial therapy has been associated with improved survival in younger
    patients with CLL. An observational study of 2040 older adults (&gt;65 years) with
    CLL who initiated infusional therapy reported superior outcomes among patients who
    received rituximab plus chemotherapy when compared with those who received
    chemotherapy alone [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/41\">",
    " 41",
    " </a>",
    " ]. Another analysis of 663 patients with previously untreated CLL enrolled on
    successive phase II and III CALGB trials demonstrated that the benefit obtained
    from rituximab was similar in younger and older adults [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/2\">",
    " 2",
    " </a>",
    " ]. Thus, we incorporate rituximab into the treatment of older adults with CLL
    and a good performance status who select treatment with a",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based regimen (ie, FCR or FR). (See",
    " <a class=\"local\" href=\"#H23868573\">",
    " 'Choice of fludarabine regimen'",
    " </a>",
    " above.)",
    " </p>",
    " <p>",
    " An alternative treatment option for older adults with poor performance status
    is lower dose of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " (25",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " IV for three consecutive days every month). In the US, the oral formulation of
    fludarabine is also approved by the FDA, but it has not yet been in widespread use.
    The recommended dosage is 40",
    " <span class=\"nowrap\">",
    " mg/m",
    " <sup>",
    " 2",
    " </sup>",
    " /day",
    " </span>",
    " for five consecutive days every month for up to six months.",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5624038\">",
    " <span class=\"h2\">",
    " High-risk disease: del(17p) or del(11q)",
    " </span>",
    " &nbsp;&mdash;&nbsp;Patients with del(17p) or del(11q) are at high risk of
    either not responding to initial treatment, or relapsing soon after achieving
    remission. As an example, one study reported median survival rates are
    approximately 3, 7, and 11 years for patients with del(17p), del(11q), or normal
    cytogenetics, respectively [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/42\">",
    " 42",
    " </a>",
    " ]. At the time of initial diagnosis, these patients should be referred to a
    transplant center for evaluation for possible allogeneic hematopoietic cell
    transplantation. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/61/35800?
    source=see_link\">",
    " \"Hematopoietic cell transplantation in chronic lymphocytic leukemia\"",
    " </a>",
    " .)",
    " </p>",
    " <p>",
    " The appropriate treatment for these patients remains undefined at this time.
    These patients should be encouraged to enroll in clinical trials, whenever
    possible. Treatment options include:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Initial treatment with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " combinations (eg, fludarabine plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " , FCR), followed by",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " , either after a number of cycles of initial debulking chemotherapy, or at
    the time of relapse. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?29/46/30442?
    source=see_link&amp;anchor=H7#H7\">",
    " \"Treatment of relapsed or refractory chronic lymphocytic leukemia\",
    section on 'Alemtuzumab'",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " Initial treatment with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?30/25/31129?
    source=see_link\">",
    " methylprednisolone",
    " </a>",
    " </li>",
    " <li>",
    " Consideration of non-myeloablative allogeneic hematopoietic cell
    transplantation (HCT) for younger patients with a matched related or matched
    unrelated donor. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/61/35800?
    source=see_link\">",
    " \"Hematopoietic cell transplantation in chronic lymphocytic leukemia\"",
    " </a>",
    " .)",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " Alemtuzumab",
    " </a>",
    " is the only FDA-approved agent that has demonstrated activity in cells lacking
    p53 function, as seen in patients with CLL and chromosome 17p deletion [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/43-46\">",
    " 43-46",
    " </a>",
    " ]. As such, we and others advocate the incorporation of alemtuzumab into the
    treatment of patients with del(17p) [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/39\">",
    " 39",
    " </a>",
    " ].",
    " </p>",
    " <p>",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " Alemtuzumab",
    " </a>",
    " appears to be less toxic when administered as consolidation therapy following
    initial",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapy than when administered concurrently with other therapies. As
    such, we typically administer FCR followed by alemtuzumab therapy and referral for
    possible non-myeloablative allogeneic HCT. The following is a selection of
    prospective trials that have evaluated the use of alemtuzumab consolidation after
    fludarabine-based therapy:",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " A prospective, randomized phase III trial also evaluated the use of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " consolidation after complete or partial remission with a",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based regimen [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/47\">",
    " 47",
    " </a>",
    " ]. This trial was stopped prematurely after enrollment of 21 patients due to
    severe infections (cytomegalovirus reactivations and pulmonary aspergillosis) in
    more than half of the patients treated with alemtuzumab. However, when the results
    of all the patients who had been entered in the study were analyzed, it was noted
    that after a median follow-up of 48 months, patients who received alemtuzumab
    consolidation had significantly higher rates of three-year progression-free
    survival (82 versus 30 percent) when compared with those who did not receive
    alemtuzumab.",
    " </li>",
    " <li>",
    " A prospective, single-arm trial evaluated the use of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " (FR) followed by",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " therapy for 41 previously untreated patients with CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/48\">",
    " 48",
    " </a>",
    " ]. This regimen was poorly tolerated with only half of the enrolled patients
    completing the intended therapy mostly related to infectious complications or
    infusion reactions with alemtuzumab.",
    " </li>",
    " <li>",
    " A prospective trial evaluated six cycles of FR followed by",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " therapy in 102 patients with previously untreated symptomatic CLL [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/49\">",
    " 49",
    " </a>",
    " ]. While consolidation with alemtuzumab deepened the responses initially
    seen with FR, it was associated with serious infections and five infection-related
    deaths, which occurred up to seven months after last therapy. Therefore, this
    combination cannot be recommended outside of a carefully monitored clinical
    trial.",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " In a multicenter phase II trial, 17 previously untreated and 22 previously
    treated patients with CLL lacking p53 function received",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?source=see_link\">",
    " alemtuzumab",
    " </a>",
    " (30 mg three times a week) plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?30/25/31129?source=see_link\">",
    " methylprednisolone",
    " </a>",
    " (1",
    " <span class=\"nowrap\">",
    " g/m",
    " <sup>",
    " 2",
    " </sup>",
    " </span>",
    " for five consecutive days) administered every four weeks for up to 16 weeks of
    treatment [",
    " <a class=\"abstract\" href=\"UTD.htm?6/13/6362/abstract/50\">",
    " 50",
    " </a>",
    " ]. All patients received antimicrobial prophylaxis with cotrimoxazole,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?20/15/20730?source=see_link\">",
    " itraconazole",
    " </a>",
    " , and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/7/31856?source=see_link\">",
    " acyclovir",
    " </a>",
    " (or",
    " <a class=\"drug drug_general\" href=\"UTD.htm?5/37/5718?source=see_link\">",
    " valganciclovir",
    " </a>",
    " ). On subset analysis of previously untreated patients, overall and complete
    responses were seen in 15 patients (88 percent) and 11 patients (65 percent),
    respectively. Median progression-free and overall survivals were 11.8 and 23.5
    months, respectively. Treatment-related mortality was 5 percent. The most common
    severe (grade",
    " <span class=\"nowrap\">",
    " 3/4)",
    " </span>",
    " toxicities were neutropenia (64 percent), infection (51 percent),
    thrombocytopenia (31 percent), anemia (31 percent), and glucocorticoid-associated
    toxicity (23 percent).",
    " </p>",
    " <p class=\"headingAnchor\" id=\"H5623578\">",
    " <span class=\"h1\">",
    " SUMMARY AND RECOMMENDATIONS",
    " </span>",
    " </p>",
    " <p>",
    " <ul class=\"bullet-block\">",
    " <li>",
    " Chronic lymphocytic leukemia (CLL) is one of the chronic lymphoproliferative
    disorders and is characterized by a progressive accumulation of functionally
    incompetent lymphocytes, which are monoclonal in origin. CLL is considered to be
    identical (ie, one disease at different stages) to the mature (peripheral) B cell
    neoplasm small lymphocytic lymphoma (SLL). (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?28/42/29352?
    source=see_link&amp;anchor=H1#H1\">",
    " \"Overview of the treatment of chronic lymphocytic leukemia\", section on
    'Introduction'",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " CLL is an extremely heterogeneous disease and not all patients require
    treatment at the time of diagnosis. Therapy is indicated for patients with advanced
    stage disease, high tumor burden, severe disease-related \"B\" symptoms, or
    repeated infections. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?28/42/29352?
    source=see_link&amp;anchor=H2#H2\">",
    " \"Overview of the treatment of chronic lymphocytic leukemia\", section on
    'Indications for treatment'",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " Prior to the initiation of active therapy for patients with symptomatic
    disease, patients with CLL should undergo a pre-treatment evaluation to determine
    the extent of disease, patient performance status, and assessment of comorbidities
    that are likely to have an impact on treatment options. (See",
    " <a class=\"medical medical_review\" href=\"UTD.htm?28/42/29352?
    source=see_link&amp;anchor=H5625565#H5625565\">",
    " \"Overview of the treatment of chronic lymphocytic leukemia\", section on
    'Pre-treatment evaluation'",
    " </a>",
    " .)",
    " </li>",
    " <li>",
    " There is no agreed upon standard front-line treatment regimen for
    symptomatic CLL or advanced SLL. There are several initial treatment options for
    patients with symptomatic CLL or advanced SLL. Most have not been directly
    compared. While overall survival rates with the different available regimens are
    similar, they differ in their rates of complete remission (CR), time to
    progression, and associated toxicities. A choice between these therapies is made
    based upon patient characteristics and goals of therapy. Median overall survival
    with each of these regimens is approximately five years. (See",
    " <a class=\"local\" href=\"#H5622415\">",
    " 'Initial therapy'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " For most patients, we suggest the use of",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapies rather than more recently approved agents, such as",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/20/32071?
    source=see_link\">",
    " bendamustine",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " (",
    " <a class=\"grade\" href=\"._grade_6?title=Grade 2C\">",
    " Grade 2C",
    " </a>",
    " ). Specifically, we use combination therapy with either fludarabine plus",
    " <a class=\"drug drug_general\" href=\"UTD.htm?40/12/41161?
    source=see_link\">",
    " rituximab",
    " </a>",
    " (FR) (",
    " <a class=\"graphic graphic_table graphicRef86798 \" href=\"UTD.htm?
    1/32/1550\">",
    " table 2",
    " </a>",
    " ) or fludarabine,",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9546?source=see_link\">",
    " cyclophosphamide",
    " </a>",
    " , and rituximab (FCR) (",
    " <a class=\"graphic graphic_table graphicRef86797 \" href=\"UTD.htm?
    22/3/22590\">",
    " table 1",
    " </a>",
    " ). (See",
    " <a class=\"local\" href=\"#H5622422\">",
    " 'Fludarabine-based therapy'",
    " </a>",
    " above.)",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " <ul class=\"hyphen-block\">",
    " <li>",
    " FR results in overall response and CR rates of approximately 90 and 47
    percent, respectively. The administration of FR to patients with CLL can be
    complicated by infusion-related reactions and tumor lysis syndrome. Several
    variations on dose and schedule have been used. (See",
    " <a class=\"local\" href=\"#H23868398\">",
    " 'Fludarabine plus rituximab'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " FCR results in overall response and CR rates of approximately 95 and 70
    percent, respectively. CR achieved with FCR appears to be \"deeper\" with frequent
    cases demonstrating no detectable disease on flow cytometry. The FCR regimen has
    been administered in different variations. (See",
    " <a class=\"local\" href=\"#H5622436\">",
    " 'Fludarabine, cyclophosphamide, and rituximab'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " Both",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " and",
    " <a class=\"drug drug_general\" href=\"UTD.htm?31/20/32071?
    source=see_link\">",
    " bendamustine",
    " </a>",
    " have been compared with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?
    source=see_link\">",
    " chlorambucil",
    " </a>",
    " in prospective, randomized trials that have demonstrated superior response
    rates with the newer agents. No survival benefits have been noted and these agents
    have not been compared directly with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " -based therapy. (See",
    " <a class=\"local\" href=\"#H23869242\">",
    " 'Alemtuzumab'",
    " </a>",
    " above and",
    " <a class=\"local\" href=\"#H23868301\">",
    " 'Bendamustine-based therapy'",
    " </a>",
    " above.)",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " <ul class=\"bulletCompact-block\">",
    " <li>",
    " While most patients with symptomatic or advanced stage CLL are treated
    similarly, older patients (&gt;60 years) and patients with del(17p) or del(11q)
    require particular consideration:",
    " </li>",
    " </ul>",
    " </p>",
    " <p>",
    " <ul class=\"hyphen-block\">",
    " <li>",
    " For older adults with symptomatic CLL, we suggest initial treatment with",
    " <a class=\"drug drug_general\" href=\"UTD.htm?34/52/35654?
    source=see_link\">",
    " chlorambucil",
    " </a>",
    " rather than",
    " <a class=\"drug drug_general\" href=\"UTD.htm?9/20/9545?source=see_link\">",
    " fludarabine",
    " </a>",
    " or other agents (",
    " <a class=\"grade\" href=\"._grade_6?title=Grade 2C\">",
    " Grade 2C",
    " </a>",
    " ). (See",
    " <a class=\"local\" href=\"#H5624031\">",
    " 'Older adults'",
    " </a>",
    " above.)",
    " </li>",
    " <li>",
    " Patients with del(17p) or del(11q) are at high risk of either not responding
    to initial treatment, or relapsing soon after achieving remission and should be
    encouraged to participate in clinical trials. For these patients, we suggest
    initial treatment with FCR, followed by",
    " <a class=\"drug drug_general\" href=\"UTD.htm?25/25/26008?
    source=see_link\">",
    " alemtuzumab",
    " </a>",
    " (",
    " <a class=\"grade\" href=\"._grade_6?title=Grade 2C\">",
    " Grade 2C",
    " </a>",
    " ). Younger patients with a matched related or matched unrelated donor are
    considered for non-myeloablative allogeneic hematopoietic cell transplantation.
    (See",
    " <a class=\"local\" href=\"#H5624038\">",
    " 'High-risk disease: del(17p) or del(11q)'",
    " </a>",
    " above.)",
    " </li>",
    " </ul>",
    " </p>",
    " </div>",
    " <div id=\"topicAgreement\">",
    " Use of UpToDate is subject to the",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_in_page\"
    target=\"_blank\">",
    " Subscription and License Agreement",
    " </a>",
    " .",
    " </div>",
    " <div class=\"headingAnchor\" id=\"references\">",
    " <h1>",
    " REFERENCES",
    " </h1>",
    " <ol id=\"reference\">",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/1\">",
    " Gill S, Carney D, Ritchie D, et al. The frequency, manifestations, and
    duration of prolonged cytopenias after first-line fludarabine combination
    chemotherapy. Ann Oncol 2010; 21:331.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/2\">",
    " Woyach JA, Ruppert AS, Rai K, et al. Impact of age on outcomes after initial
    therapy with chemotherapy and different chemoimmunotherapy regimens in patients
    with chronic lymphocytic leukemia: results of sequential cancer and leukemia group
    B studies. J Clin Oncol 2013; 31:440.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/3\">",
    " Bauer K, Rancea M, Roloff V, et al. Rituximab, ofatumumab and other
    monoclonal anti-CD20 antibodies for chronic lymphocytic leukaemia. Cochrane
    Database Syst Rev 2012; 11:CD008079.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/4\">",
    " Wierda WG, Kipps TJ, D&uuml;rig J, et al. Chemoimmunotherapy with O-FC in
    previously untreated patients with chronic lymphocytic leukemia. Blood 2011;
    117:6450.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/5\">",
    " Cazin B, Divine M, Lepr&ecirc;tre S, et al. High efficacy with five days
    schedule of oral fludarabine phosphate and cyclophosphamide in patients with
    previously untreated chronic lymphocytic leukaemia. Br J Haematol 2008; 143:54.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/6\">",
    " Hallek M, Fischer K, Fingerle-Rowson G, et al. Addition of rituximab to
    fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a
    randomised, open-label, phase 3 trial. Lancet 2010; 376:1164.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/7\">",
    " Steurer M, Pall G, Richards S, et al. Purine antagonists for chronic
    lymphocytic leukaemia. Cochrane Database Syst Rev 2006; :CD004270.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/8\">",
    " Rai KR, Peterson BL, Appelbaum FR, et al. Long-term survival analysis of the
    north american intergroup study C9011 comparing fludarabine (F) and chlorambucil
    (C) in previously untreated patients with chronic lymphocytic leukemia (abstract
    536). Blood 2009; 114:224.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/9\">",
    " Keating MJ, O'Brien S, Albitar M, et al. Early results of a
    chemoimmunotherapy regimen of fludarabine, cyclophosphamide, and rituximab as
    initial therapy for chronic lymphocytic leukemia. J Clin Oncol 2005; 23:4079.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/10\">",
    " Tam CS, Wolf M, Prince HM, et al. Fludarabine, cyclophosphamide, and
    rituximab for the treatment of patients with chronic lymphocytic leukemia or
    indolent non-Hodgkin lymphoma. Cancer 2006; 106:2412.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/11\">",
    " Foon KA, Boyiadzis M, Land SR, et al. Chemoimmunotherapy with low-dose
    fludarabine and cyclophosphamide and high dose rituximab in previously untreated
    patients with chronic lymphocytic leukemia. J Clin Oncol 2009; 27:498.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/12\">",
    " Lamanna N, Jurcic JG, Noy A, et al. Sequential therapy with fludarabine,
    high-dose cyclophosphamide, and rituximab in previously untreated patients with
    chronic lymphocytic leukemia produces high-quality responses: molecular remissions
    predict for durable complete responses. J Clin Oncol 2009; 27:491.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/13\">",
    " Foon KA, Mehta D, Lentzsch S, et al. Long-term results of chemoimmunotherapy
    with low-dose fludarabine, cyclophosphamide and high-dose rituximab as initial
    treatment for patients with chronic lymphocytic leukemia. Blood 2012; 119:3184.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/14\">",
    " Ferrario A, Pulsoni A, Olivero B, et al. Fludarabine, cyclophosphamide, and
    rituximab in patients with advanced, untreated, indolent B-cell nonfollicular
    lymphomas: phase 2 study of the Italian Lymphoma Foundation. Cancer 2012;
    118:3954.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/15\">",
    " Tam CS, O'Brien S, Wierda W, et al. Long-term results of the fludarabine,
    cyclophosphamide, and rituximab regimen as initial therapy of chronic lymphocytic
    leukemia. Blood 2008; 112:975.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/16\">",
    " Bosch F, Abrisqueta P, Villamor N, et al. Rituximab, fludarabine,
    cyclophosphamide, and mitoxantrone: a new, highly active chemoimmunotherapy regimen
    for chronic lymphocytic leukemia. J Clin Oncol 2009; 27:4578.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/17\">",
    " Byrd JC, Peterson BL, Morrison VA, et al. Randomized phase 2 study of
    fludarabine with concurrent versus sequential treatment with rituximab in
    symptomatic, untreated patients with B-cell chronic lymphocytic leukemia: results
    from Cancer and Leukemia Group B 9712 (CALGB 9712). Blood 2003; 101:6.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/18\">",
    " Woyach JA, Ruppert AS, Heerema NA, et al. Chemoimmunotherapy with
    fludarabine and rituximab produces extended overall survival and progression-free
    survival in chronic lymphocytic leukemia: long-term follow-up of CALGB study 9712.
    J Clin Oncol 2011; 29:1349.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/19\">",
    " Byrd JC, Rai K, Peterson BL, et al. Addition of rituximab to fludarabine may
    prolong progression-free survival and overall survival in patients with previously
    untreated chronic lymphocytic leukemia: an updated retrospective comparative
    analysis of CALGB 9712 and CALGB 9011. Blood 2005; 105:49.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/20\">",
    " Knauf WU, Lissichkov T, Aldaoud A, et al. Phase III randomized study of
    bendamustine compared with chlorambucil in previously untreated patients with
    chronic lymphocytic leukemia. J Clin Oncol 2009; 27:4378.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/21\">",
    " Knauf WU, Lissitchkov T, Aldaoud A, et al. Bendamustine compared with
    chlorambucil in previously untreated patients with chronic lymphocytic leukaemia:
    updated results of a randomized phase III trial. Br J Haematol 2012; 159:67.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/22\">",
    " Fischer K, Cramer P, Busch R, et al. Bendamustine in combination with
    rituximab for previously untreated patients with chronic lymphocytic leukemia: a
    multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group.
    J Clin Oncol 2012; 30:3209.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/23\">",
    " Kay NE, Geyer SM, Call TG, et al. Combination chemoimmunotherapy with
    pentostatin, cyclophosphamide, and rituximab shows significant clinical activity
    with low accompanying toxicity in previously untreated B chronic lymphocytic
    leukemia. Blood 2007; 109:405.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/24\">",
    " Samaniego F, Fanale M, Pro B, et al. Pentostatin, cyclophosphamide, and
    rituximab achieve high response rates in indolent B-cell lymphoma without prolonged
    myelosuppression (abstract 835). Blood 2008; 112:309.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/25\">",
    " Dillman RO, Mick R, McIntyre OR. Pentostatin in chronic lymphocytic
    leukemia: a phase II trial of Cancer and Leukemia group B. J Clin Oncol 1989;
    7:433.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/26\">",
    " Oken MM, Lee S, Kay NE, et al. Pentostatin, chlorambucil and prednisone
    therapy for B-chronic lymphocytic leukemia: a phase I/II study by the Eastern
    Cooperative Oncology Group study E1488. Leuk Lymphoma 2004; 45:79.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/27\">",
    " Shanafelt TD, Lin T, Geyer SM, et al. Pentostatin, cyclophosphamide, and
    rituximab regimen in older patients with chronic lymphocytic leukemia. Cancer 2007;
    109:2291.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/28\">",
    " Kay NE, Wu W, Kabat B, et al. Pentostatin and rituximab therapy for
    previously untreated patients with B-cell chronic lymphocytic leukemia. Cancer
    2010; 116:2180.",
    " </a>",
    " </li>",
    " <li>",
    " file://www.campath.com/index.html (Accessed on September 27, 2012).",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/30\">",
    " Keating MJ, Flinn I, Jain V, et al. Therapeutic role of alemtuzumab
    (Campath-1H) in patients who have failed fludarabine: results of a large
    international study. Blood 2002; 99:3554.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/31\">",
    " O'Brien SM, Kantarjian HM, Thomas DA, et al. Alemtuzumab as treatment for
    residual disease after chemotherapy in patients with chronic lymphocytic leukemia.
    Cancer 2003; 98:2657.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/32\">",
    " Fiegl M, Falkner A, Hopfinger G, et al. Routine clinical use of alemtuzumab
    in patients with heavily pretreated B-cell chronic lymphocytic leukemia: a nation-
    wide retrospective study in Austria. Cancer 2006; 107:2408.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/33\">",
    " Moreton P, Kennedy B, Lucas G, et al. Eradication of minimal residual
    disease in B-cell chronic lymphocytic leukemia after alemtuzumab therapy is
    associated with prolonged survival. J Clin Oncol 2005; 23:2971.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/34\">",
    " Hillmen P, Skotnicki AB, Robak T, et al. Alemtuzumab compared with
    chlorambucil as first-line therapy for chronic lymphocytic leukemia. J Clin Oncol
    2007; 25:5616.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/35\">",
    " Lundin J, Kimby E, Bj&ouml;rkholm M, et al. Phase II trial of subcutaneous
    anti-CD52 monoclonal antibody alemtuzumab (Campath-1H) as first-line treatment for
    patients with B-cell chronic lymphocytic leukemia (B-CLL). Blood 2002; 100:768.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/36\">",
    " Lepretre S, Aurran T, Mah&eacute; B, et al. Excess mortality after treatment
    with fludarabine and cyclophosphamide in combination with alemtuzumab in previously
    untreated patients with chronic lymphocytic leukemia in a randomized phase 3 trial.
    Blood 2012; 119:5104.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/37\">",
    " Parikh SA, Keating MJ, O'Brien S, et al. Frontline chemoimmunotherapy with
    fludarabine, cyclophosphamide, alemtuzumab, and rituximab for high-risk chronic
    lymphocytic leukemia. Blood 2011; 118:2062.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/38\">",
    " Eichhorst BF, Busch R, Stilgenbauer S, et al. First-line therapy with
    fludarabine compared with chlorambucil does not result in a major benefit for
    elderly patients with advanced chronic lymphocytic leukemia. Blood 2009;
    114:3382.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/39\">",
    " Gribben JG. How I treat CLL up front. Blood 2010; 115:187.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/40\">",
    " Polizzotto MN, Tam CS, Milner A, et al. The influence of increasing age on
    the deliverability and toxicity of fludarabine-based combination chemotherapy
    regimens in patients with indolent lymphoproliferative disorders. Cancer 2006;
    107:773.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/41\">",
    " Danese MD, Griffiths RI, Gleeson M, et al. An observational study of
    outcomes after initial infused therapy in Medicare patients diagnosed with chronic
    lymphocytic leukemia. Blood 2011; 117:3505.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/42\">",
    " D&ouml;hner H, Stilgenbauer S, Benner A, et al. Genomic aberrations and
    survival in chronic lymphocytic leukemia. N Engl J Med 2000; 343:1910.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/43\">",
    " Lozanski G, Heerema NA, Flinn IW, et al. Alemtuzumab is an effective therapy
    for chronic lymphocytic leukemia with p53 mutations and deletions. Blood 2004;
    103:3278.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/44\">",
    " Ravandi F, O'brien S. Alemtuzumab in CLL and other lymphoid neoplasms.
    Cancer Invest 2006; 24:718.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/45\">",
    " Osuji NC, Del Giudice I, Matutes E, et al. The efficacy of alemtuzumab for
    refractory chronic lymphocytic leukemia in relation to cytogenetic abnormalities of
    p53. Haematologica 2005; 90:1435.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/46\">",
    " Pettitt AR, Matutes E, Oscier D. Alemtuzumab in combination with high-dose
    methylprednisolone is a logical, feasible and highly active therapeutic regimen in
    chronic lymphocytic leukaemia patients with p53 defects. Leukemia 2006; 20:1441.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/47\">",
    " Schweighofer CD, Ritgen M, Eichhorst BF, et al. Consolidation with
    alemtuzumab improves progression-free survival in patients with chronic lymphocytic
    leukaemia (CLL) in first remission: long-term follow-up of a randomized phase III
    trial of the German CLL Study Group (GCLLSG). Br J Haematol 2009; 144:95.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/48\">",
    " Hainsworth JD, Vazquez ER, Spigel DR, et al. Combination therapy with
    fludarabine and rituximab followed by alemtuzumab in the first-line treatment of
    patients with chronic lymphocytic leukemia or small lymphocytic lymphoma: a phase 2
    trial of the Minnie Pearl Cancer Research Network. Cancer 2008; 112:1288.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/49\">",
    " Lin TS, Donohue KA, Byrd JC, et al. Consolidation therapy with subcutaneous
    alemtuzumab after fludarabine and rituximab induction therapy for previously
    untreated chronic lymphocytic leukemia: final analysis of CALGB 10101. J Clin Oncol
    2010; 28:4500.",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"nounderline abstract\" href=\"UTD.htm?6/13/6362/abstract/50\">",
    " Pettitt AR, Jackson R, Carruthers S, et al. Alemtuzumab in combination with
    methylprednisolone is a highly effective induction regimen for patients with
    chronic lymphocytic leukemia and deletion of TP53: final results of the national
    cancer research institute CLL206 trial. J Clin Oncol 2012; 30:1647.",
    " </a>",
    " </li>",
    " </ol>",
    " </div>",
    " <div id=\"topicVersionRevision\">",
    " Topic 83749 Version 8.0",
    " </div>",
    " </div>",
    " <div id=\"footer\">",
    " <div id=\"supportFooter\">",
    " <span class=\"sfInfo\">",
    " &copy; 2013 UpToDate, Inc. All rights reserved.",
    " </span>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a class=\"licenseLink\" href=\"./license\" id=\"sla_footer\">",
    " Subscription and License Agreement",
    " </a>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Release: 21.6- C21.56",
    " </span>",
    " <br/>",
    " <span class=\"sfInfo\">",
    " Licensed to:",
    " <span class=\"emphasis\">",
    " AsanBook Dig. Med. Lib.",
    " </span>",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Support Tag: [0602-201.77.166.39-6D34BE7A96-S244013.14]",
    " <br/>",
    " </span>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6362=[""].join("\n");
    var outline_f6_13_6362=[" <div id=\"toggleOutline\">",
    " <a href=\"#\" title=\"Collapse Topic Outline\">",
    " <img alt=\"\" src=\"./../images/orange_arrow_left.myextg\"/>",
    " </a>",
    " </div>",
    " <div id=\"innerOutline\">",
    " <h1>",
    " TOPIC OUTLINE",
    " </h1>",
    " <div id=\"outline\">",
    " <ul>",
    " <li>",
    " <a class=\"sr_button\" href=\"#H5623578\" id=\"summRecButton\">",
    " <span>",
    " SUMMARY &amp; RECOMMENDATIONS",
    " </span>",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H5623314\">",
    " INTRODUCTION",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H5622415\">",
    " INITIAL THERAPY",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H1664568\">",
    " Our general approach",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H5622422\">",
    " Fludarabine-based therapy",
    " </a>",
    " </li>",
    " <li class=\"dashItem\">",
    " <a class=\"outlineLink\" href=\"#H23868573\">",
    " - Choice of fludarabine regimen",
    " </a>",
    " </li>",
    " <li class=\"dashItem\">",
    " <a class=\"outlineLink\" href=\"#H5622436\">",
    " - Fludarabine, cyclophosphamide, and rituximab",
    " </a>",
    " </li>",
    " <li class=\"dashItem\">",
    " <a class=\"outlineLink\" href=\"#H23868398\">",
    " - Fludarabine plus rituximab",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H23868301\">",
    " Bendamustine-based therapy",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H23868177\">",
    " Pentostatin-based therapy",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H23869242\">",
    " Alemtuzumab",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H5624009\">",
    " SPECIAL PATIENT POPULATIONS",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H5624031\">",
    " Older adults",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"outlineLink\" href=\"#H5624038\">",
    " High-risk disease: del(17p) or del(11q)",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"outlineLink\" href=\"#H5623578\">",
    " SUMMARY AND RECOMMENDATIONS",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a href=\"#references\">",
    " REFERENCES",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " <div class=\"openRelatedGraphics\" id=\"HEME/83749\" rel=\"outline_link\">",
    " GRAPHICS",
    " <a class=\"graphics_icon\" href=\"#\" title=\"View All Related Graphics\">",
    " View All",
    " </a>",
    " </div>",
    " </h1>",
    " <div id=\"relatedGraphics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <div class=\"openRelatedGraphics\" id=\"HEME/83749|TAB\">",
    " <a href=\"#\" title=\"TABLES\">",
    " TABLES",
    " </a>",
    " </div>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?22/3/22590\" title=\"table
    1\">",
    " FCR for CLL",
    " </a>",
    " </li>",
    " <li class=\"bulletItem\">",
    " <a class=\"graphic graphic_table\" href=\"UTD.htm?1/32/1550\" title=\"table
    2\">",
    " FR for CLL",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <h1>",
    " RELATED TOPICS",
    " </h1>",
    " <div id=\"relatedTopics\">",
    " <ul>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?8/29/8665?
    source=related_link\">",
    " Autoimmune complications following purine analog therapy",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?40/56/41864?
    source=related_link\">",
    " Comprehensive geriatric assessment for patients with cancer",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?24/6/24680?
    source=related_link\">",
    " Epidemiology and clinical manifestations of chronic lymphocytic leukemia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?24/32/25098?
    source=related_link\">",
    " General toxicity of cyclophosphamide and chlorambucil in inflammatory
    diseases",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/61/35800?
    source=related_link\">",
    " Hematopoietic cell transplantation in chronic lymphocytic leukemia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?0/25/410?
    source=related_link\">",
    " Overview of infectious complications following purine analog therapy",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/12/35017?
    source=related_link\">",
    " Overview of the complications of chronic lymphocytic leukemia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?28/42/29352?
    source=related_link\">",
    " Overview of the treatment of chronic lymphocytic leukemia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?34/38/35431?
    source=related_link\">",
    " Pathologic features, diagnosis, and differential diagnosis of chronic
    lymphocytic leukemia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?41/23/42361?
    source=related_link\">",
    " Pathophysiology and genetic features of chronic lymphocytic leukemia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?15/6/15466?
    source=related_link\">",
    " Staging and prognosis of chronic lymphocytic leukemia",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?10/42/10922?
    source=related_link\">",
    " Systemic chemotherapy for cancer in elderly persons",
    " </a>",
    " </li>",
    " <li class=\"plainItem\">",
    " <a class=\"medical medical_review\" href=\"UTD.htm?29/46/30442?
    source=related_link\">",
    " Treatment of relapsed or refractory chronic lymphocytic leukemia",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " </div>"].join("\n");
    var title_f6_13_6363="Indoor fungi";
    var content_f6_13_6363=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=ALLRG
    %2F67631&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=6\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=ALLRG
    %2F67631&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=6\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\">",
    " <div class=\"ttl\">",
    " Common indoor fungi",
    " </div>",
    " <div class=\"cntnt\">",
    " <table cellspacing=\"0\">",
    " <tbody>",
    " <tr>",
    " <td>",
    " <em>",
    " Cladosporium",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Alternaria",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Epicoccum",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Fusarium",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Penicillium",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Aspergillus",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Geotrichum",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Rhodotorula",
    " </em>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <em>",
    " Chaetomium",
    " </em>",
    " </td>",
    " </tr>",
    " </tbody>",
    " </table>",
    " </div>",
    " <div class=\"lgnd\">",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " Courtesy of Robert Bush, MD.",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6363=[""].join("\n");
    var outline_f6_13_6363=null;
    var title_f6_13_6364="High risk conditions for invasive pneumococcal disease";
    var content_f6_13_6364=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=PEDS
    %2F68655&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=2\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=PEDS
    %2F68655&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=2\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\">",
    " <div class=\"ttl\">",
    " Underlying medical conditions that are indications for pneumococcal
    polysaccharide vaccination among children, by risk group - Advisory Committee on
    Immunization Practices (ACIP), United States, 2010",
    " </div>",
    " <div class=\"cntnt\">",
    " <table cellspacing=\"0\">",
    " <tbody>",
    " <tr>",
    " <td class=\"subtitle1\">",
    " Risk group",
    " </td>",
    " <td class=\"subtitle1\">",
    " Condition",
    " </td>",
    " </tr>",
    " <tr>",
    " <td rowspan=\"5\">",
    " Immunocompetent children",
    " </td>",
    " <td>",
    " Chronic heart disease*",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Chronic lung disease",
    " <sup>",
    " &bull;",
    " </sup>",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Diabetes mellitus",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Cerebrospinal fluid leaks",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Cochlear implant",
    " </td>",
    " </tr>",
    " <tr class=\"divider_top\">",
    " <td rowspan=\"2\">",
    " Children with functional or anatomic asplenia",
    " </td>",
    " <td>",
    " Sickle cell disease and other hemoglobinopathies",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Congenital or acquired asplenia, or splenic dysfunction",
    " </td>",
    " </tr>",
    " <tr class=\"divider_top\">",
    " <td rowspan=\"4\">",
    " Children with immunocompromising conditions",
    " </td>",
    " <td>",
    " HIV infection",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Chronic renal failure and nephrotic syndrome",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Diseases associated with treatment with immunosuppressive drugs or
    radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin
    disease; or solid organ transplantation",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Congenital immunodeficiency",
    " <sup>",
    " &Delta;",
    " </sup>",
    " </td>",
    " </tr>",
    " </tbody>",
    " </table>",
    " </div>",
    " <div class=\"lgnd\">",
    " <div class=\"footnotes\">",
    " * Particularly cyanotic congenital heart disease and cardiac failure.",
    " <br>",
    " <span class=\"bullet\">",
    " &bull;",
    " </span>",
    " Including asthma if treated with prolonged high-dose oral corticosteroids.",
    " <br>",
    " &Delta; Includes B- (humoral) or T-lymphocyte deficiency; complement
    deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders
    (excluding chronic granulomatous disease).",
    " </br>",
    " </br>",
    " </div>",
    " <div class=\"reference\">",
    " From Centers for Disease Control and Prevention. Licensure of a 13-Valent
    Pneumococcal Conjugate Vaccine (PCV13) and Recommendations for Use Among Children -
    Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010; 59:260.",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6364=[""].join("\n");
    var outline_f6_13_6364=null;
    var title_f6_13_6365="Path mastect occ prim breast CA";
    var content_f6_13_6365=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=ONC
    %2F52940&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=2\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=ONC
    %2F52940&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=2\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\">",
    " <div class=\"ttl\">",
    " Pathologic findings at mastectomy in patients with occult primary breast
    cancer",
    " </div>",
    " <div class=\"cntnt\">",
    " <table cellspacing=\"0\">",
    " <tbody>",
    " <tr>",
    " <td class=\"subtitle1\">",
    " Author, year",
    " </td>",
    " <td class=\"subtitle1\">",
    " Years",
    " </td>",
    " <td class=\"subtitle1\">",
    " Mastectomy, n",
    " </td>",
    " <td class=\"subtitle1\">",
    " In situ, n",
    " </td>",
    " <td class=\"subtitle1\">",
    " Invasive, n",
    " </td>",
    " <td class=\"subtitle1\">",
    " Cancer, percent",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Owens, H; 1954",
    " </td>",
    " <td>",
    " 1907-50",
    " </td>",
    " <td>",
    " 27",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 25",
    " </td>",
    " <td>",
    " 92",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Feuerman, L; 1962",
    " </td>",
    " <td>",
    " 1949-61",
    " </td>",
    " <td>",
    " 2",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 1",
    " </td>",
    " <td>",
    " 50",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Fitts, W; 1963",
    " </td>",
    " <td>",
    " 1948-63",
    " </td>",
    " <td>",
    " 11",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 7",
    " </td>",
    " <td>",
    " 70",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Haagensen, C; 1974",
    " </td>",
    " <td>",
    " 1916-66",
    " </td>",
    " <td>",
    " 13",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 12",
    " </td>",
    " <td>",
    " 92",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Ashikari, R; 1976",
    " </td>",
    " <td>",
    " 1946-75",
    " </td>",
    " <td>",
    " 34",
    " </td>",
    " <td>",
    " 3",
    " </td>",
    " <td>",
    " 20",
    " </td>",
    " <td>",
    " 67",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Patel, J; 1981",
    " </td>",
    " <td>",
    " 1952-79",
    " </td>",
    " <td>",
    " 29",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 16",
    " </td>",
    " <td>",
    " 60",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Kemeny, M; 1986",
    " </td>",
    " <td>",
    " 1973-85",
    " </td>",
    " <td>",
    " 11",
    " </td>",
    " <td>",
    " 2",
    " </td>",
    " <td>",
    " 3",
    " </td>",
    " <td>",
    " 45",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Bhatia, S; 1987",
    " </td>",
    " <td>",
    " 1977-85",
    " </td>",
    " <td>",
    " 11",
    " </td>",
    " <td>",
    " 2",
    " </td>",
    " <td>",
    " 9",
    " </td>",
    " <td>",
    " 100",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Baron, P; 1990",
    " </td>",
    " <td>",
    " 1975-78",
    " </td>",
    " <td>",
    " 28",
    " </td>",
    " <td>",
    " 4",
    " </td>",
    " <td>",
    " 16",
    " </td>",
    " <td>",
    " 71",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Ellerbroek, N; 1990",
    " </td>",
    " <td>",
    " 1944-87",
    " </td>",
    " <td>",
    " 13",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 1",
    " </td>",
    " <td>",
    " 8",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Merson, M; 1992",
    " </td>",
    " <td>",
    " 1945-87",
    " </td>",
    " <td>",
    " 33",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 27",
    " </td>",
    " <td>",
    " 82",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Feigenberg, S; 2003",
    " </td>",
    " <td>",
    " 1971-74",
    " </td>",
    " <td>",
    " 4",
    " </td>",
    " <td>",
    " 0",
    " </td>",
    " <td>",
    " 3",
    " </td>",
    " <td>",
    " 80",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " Blanchard, D; 2004",
    " </td>",
    " <td>",
    " 1975-98",
    " </td>",
    " <td>",
    " 18",
    " </td>",
    " <td>",
    " 1",
    " </td>",
    " <td>",
    " 5",
    " </td>",
    " <td>",
    " 33",
    " </td>",
    " </tr>",
    " <tr>",
    " <td>",
    " <strong>",
    " Total",
    " </strong>",
    " </td>",
    " <td>",
    " -",
    " </td>",
    " <td>",
    " 234",
    " </td>",
    " <td>",
    " 12",
    " </td>",
    " <td>",
    " 145",
    " </td>",
    " <td>",
    " 65",
    " </td>",
    " </tr>",
    " </tbody>",
    " </table>",
    " </div>",
    " <div class=\"lgnd\">",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6365=[""].join("\n");
    var outline_f6_13_6365=null;
    var title_f6_13_6366="Contents: Non pain symptoms: Assessment and management";
    var content_f6_13_6366=[" <script type=\"text/javascript\">",
    " $$.inlineInitCustomer(",
    " false);",
    " var quirksmode = document.compatMode == \"CSS1Compat\";",
    " if (quirksmode) {",
    " $(\"html\").addClass(\"ie-standards\");",
    " }",
    " </script>",
    " <div id=\"message-wrap\">",
    " <div id=\"message-bg\">",
    " </div>",
    " <iframe id=\"message-bk\">",
    " </iframe>",
    " <dl id=\"message-container\">",
    " <dt id=\"message-title\">",
    " </dt>",
    " <dd id=\"message-body\">",
    " </dd>",
    " <dd id=\"message-controls\">",
    " </dd>",
    " </dl>",
    " </div>",
    " <div id=\"topPanel\">",
    " <div id=\"header\">",
    " <div id=\"header_container\">",
    " <h2 id=\"logo\">",
    " <a href=\"./toc\">",
    " Wolters Kluwer Health UpToDate",
    " </a>",
    " </h2>",
    " <div id=\"header_right\">",
    " <div id=\"searchpanel\">",
    " <a href=\"/login\" id=\"loginbutton\">",
    " Log in",
    " </a>",
    " <div id=\"cmsSearchBox\">",
    " <div class=\"header-search\">",
    " <form action=\"./search\" id=\"cmssearch\" method=\"get\"
    name=\"SearchForm\">",
    " <div class=\"header-search-left\">",
    " <input autocomplete=\"off\" class=\"searchfield\" id=\"cmsTxtBox\"
    name=\"search\" placeholder=\"Search UpToDate\" type=\"text\"/>",
    " </div>",
    " <div class=\"header-search-right\">",
    " <input alt=\"Search\" id=\"cmsSearchSubmit\"
    src=\"/sites/all/themes/uptodate/images/search_button.png\" type=\"image\"/>",
    " </div>",
    " <div class=\"clear\">",
    " </div>",
    " </form>",
    " </div>",
    " </div>",
    " <div id=\"cms_lang_dropdown\">",
    " <form accept-charset=\"UTF-8\" action=\"/\" id=\"lang-dropdown-form\"
    method=\"post\">",
    " <div class=\"form-item form-type-select form-item-lang-dropdown-
    select\">",
    " <select class=\"lang-dropdown-select-element form-select\" id=\"edit-
    lang-dropdown-select\" name=\"lang_dropdown_select\" style=\"width:100px\">",
    " <option selected=\"selected\" value=\"en\">",
    " English",
    " </option>",
    " <option value=\"ja\">",
    " ���������������������������",
    " </option>",
    " </select>",
    " </div>",
    " <input name=\"lang_dropdown_type\" type=\"hidden\" value=\"language\">",
    " <input name=\"en\" type=\"hidden\" value=\"/\">",
    " <input name=\"ja\" type=\"hidden\" value=\"/ja\">",
    " <noscript>",
    " <div>",
    " <input class=\"form-submit\" id=\"edit-submit\" name=\"op\"
    type=\"submit\" value=\"Go\"/>",
    " </div>",
    " </noscript>",
    " <input name=\"form_build_id\" type=\"hidden\" value=\"form-
    on4lUWpxHun_wp6revUkjCG6rK2IBuCGME9Cw0HXeok\">",
    " <input name=\"form_id\" type=\"hidden\"
    value=\"lang_dropdown_form\">",
    " </input>",
    " </input>",
    " </input>",
    " </input>",
    " </input>",
    " </form>",
    " </div>",
    " <div class=\"clear\">",
    " </div>",
    " </div>",
    " <ul id=\"utility\">",
    " <li class=\"first\">",
    " <a href=\"/home/about-us\">",
    " About Us",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"/home/news-events\">",
    " News &amp; Events",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"/home/contact-us\">",
    " Contact Us",
    " </a>",
    " </li>",
    " <li class=\"last\">",
    " <a href=\"/help\">",
    " Help",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <div class=\"clear\">",
    " </div>",
    " </div>",
    " <div id=\"nav\">",
    " <ul>",
    " <li id=\"productTab\">",
    " <a href=\"/home/product\">",
    " Product",
    " <span>",
    " </span>",
    " </a>",
    " </li>",
    " <li id=\"editoralTab\">",
    " <a href=\"/home/editorial\">",
    " Editorial",
    " <span>",
    " </span>",
    " </a>",
    " </li>",
    " <li id=\"whyUptodateTab\">",
    " <a href=\"/home/why-uptodate\">",
    " Why UpToDate",
    " <span>",
    " </span>",
    " </a>",
    " </li>",
    " <li id=\"supscriptionOptionsTab\">",
    " <a href=\"/home/subscription-options\">",
    " Subscription Options",
    " <span>",
    " </span>",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"/store\">",
    " Subscribe",
    " <span>",
    " </span>",
    " </a>",
    " </li>",
    " <li id=\"wkhcsTab\">",
    " <a href=\"/home/wolters-kluwer-health-clinical-solutions\">",
    " Wolters Kluwer Health Clinical Solutions",
    " <span>",
    " </span>",
    " </a>",
    " </li>",
    " </ul>",
    " <div class=\"clear\">",
    " </div>",
    " </div>",
    " <div id=\"greyBar\">",
    " <div id=\"greyBarTitle\">",
    " <span class=\"emphasis\">",
    " <a href=\"UTD.htm?3/3/3134\">",
    " Contents",
    " </a>",
    " </span>",
    " <img src=\"./../images/space_arrows.myextg\">",
    " <a href=\"UTD.htm?34/55/35709\">",
    " Palliative Care",
    " </a>",
    " <img src=\"./../images/space_arrows.myextg\">",
    " Non pain symptoms: Assessment and management",
    " </img>",
    " </img>",
    " </div>",
    " <div id=\"greyBarButtons\">",
    " <div id=\"printGB\">",
    " <a class=\"icontxt\" href=\"?view=print\">",
    " <img align=\"middle\" alt=\"Print this page\" border=\"0\" height=\"20\"
    src=\"./../images/icn_print.myextg\" width=\"24\"/>",
    " </a>",
    " <a class=\"icontxt\" href=\"?view=print\" title=\"Print this page\">",
    " Print",
    " </a>",
    " </div>",
    " </div>",
    " </div>",
    " <!-- menuMessage.jsp -->",
    " <!-- /menuMessage.jsp -->",
    " </div>",
    " <!-- header -->",
    " </div>",
    " <!-- topPanel -->",
    " <div id=\"leftPanel\">",
    " <ul>",
    " <li>",
    " <a href=\"UTD.htm?3/45/3806\">",
    " Specialties",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"UTD.htm?18/22/18798\">",
    " Patient Information",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"UTD.htm?3/13/3294\">",
    " What's New",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"UTD.htm?0/37/606\">",
    " Calculators",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"UTD.htm?0/40/654\">",
    " Authors and Editors",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <!-- leftPanel -->",
    " <div id=\"rightPanel\">",
    " <noscript>",
    " <div id=\"javascriptDisabled\">",
    " It seems to us that you have your JavaScript turned off on your browser.
    JavaScript is required in order for our site to behave correctly. Please enable
    your JavaScript to continue use our site.",
    " </div>",
    " </noscript>",
    " <div id=\"printHeader\">",
    " <div id=\"printHeaderLogo\">",
    " <img alt=\"UpToDate\" src=\"./../images/wk_utd-rgb.myextg\" width=\"220px\">",
    " </img>",
    " </div>",
    " <div id=\"printHeaderText\">",
    " Official reprint from UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " <a href=\"file://www.uptodate.com\">",
    " www.uptodate.com",
    " </a>",
    " <br>",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </br>",
    " </div>",
    " <div id=\"printHeaderLinks\">",
    " <a href=\"#\" id=\"printHeaderPrint\" rel=\"\" title=\"Click here to
    print\">",
    " Print",
    " </a>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <a href=\"#\" id=\"printHeaderBack\" title=\"Back to normal view\">",
    " Back",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"toctable\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\"
    id=\"tocTable\" width=\"100%\">",
    " <trs>",
    " <tds>",
    " <h1>",
    " Contents:",
    " Non pain symptoms: Assessment and management",
    " </h1>",
    " </tds>",
    " </trs>",
    " <trs>",
    " <tds>",
    " </tds>",
    " </trs>",
    " <trs>",
    " <tds valign=\"top\">",
    " <div class=\"toctable\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\"
    width=\"100%\">",
    " <trs>",
    " <tds>",
    " <strong>",
    " Cardiovascular",
    " </strong>",
    " <ul>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?18/52/19273\">",
    " Cardiac tamponade",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?3/59/4025\">",
    " Diagnosis and treatment of pericardial effusion",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?18/56/19338\">",
    " Malignancy-related superior vena cava syndrome",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?1/1/1050\">",
    " Pericardial disease associated with malignancy",
    " </a>",
    " </li>",
    " </ul>",
    " <strong>",
    " Gastrointestinal",
    " </strong>",
    " <ul>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?7/3/7226\">",
    " Malignancy-associated gastroparesis: Pathophysiology and management",
    " </a>",
    " </li>",
    " </ul>",
    " <strong>",
    " General",
    " </strong>",
    " <ul>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?40/13/41178\">",
    " Approach to symptom assessment in palliative care",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?27/52/28490\">",
    " Overview of comprehensive patient assessment in palliative care",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?35/7/35962\">",
    " Overview of managing common non-pain symptoms in palliative care",
    " </a>",
    " </li>",
    " </ul>",
    " <strong>",
    " Genitourinary",
    " </strong>",
    " <ul>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?7/56/8072\">",
    " Withdrawal from and withholding of dialysis",
    " </a>",
    " </li>",
    " </ul>",
    " <strong>",
    " Neuropsychiatry",
    " </strong>",
    " <ul>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?38/10/39081\">",
    " Diagnosis of delirium and confusional states",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?6/48/6922\">",
    " Palliative care: Overview of fatigue, weakness, and asthenia",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?27/33/28185\">",
    " Prevention and treatment of delirium and confusional states",
    " </a>",
    " </li>",
    " </ul>",
    " <strong>",
    " Nutrition/fluids/metabolic",
    " </strong>",
    " <ul>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?33/26/34215\">",
    " Failure to thrive in elderly adults: Evaluation",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?41/29/42455\">",
    " Failure to thrive in elderly adults: Management",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?38/63/39928\">",
    " Malignancy-related ascites",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?42/39/43639\">",
    " Nutritional support in advanced lung disease",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?19/63/20473\">",
    " Percutaneous endoscopic gastrostomy (PEG) tubes: Uses and efficacy",
    " </a>",
    " </li>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?0/40/650\">",
    " Treatment of refractory edema in adults",
    " </a>",
    " </li>",
    " </ul>",
    " <strong>",
    " Pulmonary",
    " </strong>",
    " <ul>",
    " <li>",
    " <a class=\"tocItem\" href=\"UTD.htm?29/60/30666\">",
    " Assessment and management of dyspnea in palliative care",
    " </a>",
    " </li>",
    " </ul>",
    " </tds>",
    " </trs>",
    " </div>",
    " </tds>",
    " </trs>",
    " <trs>",
    " <tds>",
    " <img height=\"10\" src=\"./../images/spacer.myextg\" width=\"1\"/>",
    " </tds>",
    " </trs>",
    " </div>",
    " <div id=\"footer\">",
    " <div id=\"footerNav\">",
    " <ul>",
    " <li>",
    " <a href=\"file://www.wolterskluwerhealth.com/\" rel=\"nofollow\"
    target=\"_blank\">",
    " Wolters Kluwer Health",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"file://www.factsandcomparisons.com/\" rel=\"nofollow\"
    target=\"_blank\">",
    " Facts &amp; Comparisons&reg;",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"file://www.medispan.com\" rel=\"nofollow\" target=\"_blank\">",
    " Medi-Span&reg;",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"file://www.provationordersets.com\" rel=\"nofollow\"
    target=\"_blank\">",
    " ProVation&reg; Order Sets",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"file://www.provationmedical.com\" rel=\"nofollow\"
    target=\"_blank\">",
    " ProVation&reg; Medical",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"file://pharmacyonesource.com/\" rel=\"nofollow\"
    target=\"_blank\">",
    " Pharmacy OneSource&reg;",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"file://www.medicom.com.cn/\" rel=\"nofollow\" target=\"_blank\">",
    " Medicom",
    " </a>",
    " </li>",
    " <li>",
    " <a href=\"file://www.lexi.com/\" rel=\"nofollow\" target=\"_blank\">",
    " Lexicomp",
    " </a>",
    " </li>",
    " <li class=\"last\">",
    " <a href=\"/home/privacy-policy\">",
    " Privacy Policy",
    " </a>",
    " </li>",
    " </ul>",
    " </div>",
    " <div id=\"footerLogo\">",
    " <a href=\"./toc\">",
    " Wolters Kluwer Health | UpToDate",
    " </a>",
    " </div>",
    " <div id=\"supportFooter\">",
    " <span class=\"sfInfo\">",
    " &copy; 2013 UpToDate, Inc. All rights reserved.",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Release: 21.3 - C21.34",
    " </span>",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " <span class=\"sfInfo\">",
    " <a href=\"/home/terms-use\">",
    " Terms of Use",
    " </a>",
    " </span>",
    " <br/>",
    " <span class=\"sfInfo\">",
    " Licensed to:",
    " <span class=\"emphasis\">",
    " UpToDate Marketing Professional",
    " </span>",
    " </span>",
    " <span class=\"sfInfo\">",
    " <span class=\"pipeSpace\">",
    " |",
    " </span>",
    " Support Tag: [0605-95.154.198.148-B2280EB4B5-14]",
    " <br/>",
    " </span>",
    " </div>",
    " </div>",
    " </div>",
    " <!-- rightPanel -->",
    "</body>"].join("\n");
    var script_f6_13_6366=[""].join("\n");
    var outline_f6_13_6366=null;
    var title_f6_13_6367="Platelet production per nucleus";
    var content_f6_13_6367=[" <div id=\"graphicsToolbar\">",
    " <div id=\"graphicsCopy\">",
    " &copy;2013 UpToDate",
    " <sup>",
    " &reg;",
    " </sup>",
    " </div>",
    " <div id=\"graphicsLinks\">",
    " <a href=\"?imageKey=HEME
    %2F74204&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\">",
    " <img alt=\"Print this page\" src=\"./../images/icn_print.myextg\"
    title=\"Print this page\"/>",
    " </a>",
    " <a class=\"icontxt textLink\" href=\"?imageKey=HEME
    %2F74204&amp;source=image_view&amp;view=print&amp;elapsedTimeMs=1\" onclick=\"\"
    title=\"Print this page\">",
    " Print",
    " </a>",
    " <a class=\"etacLink\" href=\"#\">",
    " <img alt=\"Email graphic(s)\" src=\"./../images/icn_email.myextg\"
    title=\"Email graphic(s)\"/>",
    " </a>",
    " <a class=\"icontxt textLink etacLink\" href=\"#\" title=\"Email graphic(s)\">",
    " Email",
    " </a>",
    " </div>",
    " </div>",
    " <div class=\"graphic\">",
    " <div class=\"figure\" style=\"width: 551px\">",
    " <div class=\"ttl\">",
    " Megakaryocyte volume and platelet production per nucleus in megakaryocyte
    disorders",
    " </div>",
    " <div class=\"cntnt\" style=\"width: 531px; height: 280px; background-image:
    url(data:image/gif;base64,R0lGODlhEwIYAcQAAP///wAz//8AAICAgAAAAAAZf38AAEBAQMDAwNDQ0
    HBwcBAQEKCgoFBQUCAgIPDw8DAwMLCwsODg4GBgYJCQkD8AAAAMPwAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
    AAAAACH5BAAAAAAALAAAAAATAhgBAAX/ICCOZGmeaKqubOu+cCzPdG3feK7vfO//wKBwSCwaj8ikcslsOp/
    QqHRKrVqv2Kx2y+16v+CweEwum8/otHrNbrvf8Lh8Tq/b7/i8fs/v+/
    +AgYKDhIWGh4iJiouMjY6PkJGSk5SVlpeYmZqbnJ2en6ChoqOkpaanqKmqq6ytrq+wsbKztLW2t7iNDwwDA
    yK7AwwPIxEDFBK5yXQJCM0IwwDFx40JCwQHDiIQ1wQQIgrdCwvIyuVuBwTpBAgA4BDi5IoOBAnEBA0ADQQR
    DwQLABQIKDBHcA06Cs0e9PsXcKCiBAQczMM3gICvigMQXAOg8cAIBL1CihxJsqTJkyhT/6pcybKly5cwY8q
    cSbOmzZs4c45kJwIdhAMMOG7suEgjBATbeFkEgJEoUREgex04oLOq1atYs0qlqrWr169gRU4NybPdAAXWIj
    jd+HAjxobtCFCA6C3CvRO9CurIqxcHXxQY6Ua7u2hehG0IJEREMA+ZYX1BTfztW2NyjKgqy8ayLMKBArTrA
    DwmEPnhtgWRGcxzEDnBaYeSfVG2wfnFgAoGcuvenbuCbFm19UVs/RpV7dm2f8sYYECA8+fQnRtQDuv4LOvI
    WWBfwTy6dwHTaW2vTj178srNv0MPHwZz5jDjX8U3Hxu9+vXludzmzb93fi3ztRIgfSMMWEJ390n3H/
    +A6SUI3oJYGKiKhE64h5JmhVAoAoIJsgcGhx1CeIWGp5C4xAAWFKDiiiyqaIGIfpAIonoeLmHhhQU2GGIJN
    5qE4REmlhJkEgMUEMCRARCA5JJLISKjjjTCKMR+/fHmW44OKnggblXqduWJUroyJBJFLmkmkgWEuceTWdao
    xIxRYtkmdXB65yaQarIyJpAFKHmmnwGkmQibDt5JJpRxbojod27WGZ2hRewZiqSRGnmmmYI6meeBiz66aQ+
    OeipnoXR2ih8TlH6S6hBlIgkok5/eQeiOTYR6qqJZPsjpnKjGapyvqFp6KZrA0jHrfZAaYetzHi6rJQnOJs
    tqsUJSS2T/n5cCmukhxyaKqqm3MgUus6XyCqYyq04p7LCBWhtHt4y6a5+54uba6Li6nptMukG0euSrrsr7B
    rx2CjyDs/nWSy+upPaKrsFE+MvutoYQLGqt+CaM8L0LkwmxJ/wCUSTA/xI7KLDRfgzDxr+xvGvD+uYS8g8S
    D0vxFz2W9OPKKOMrbcQZNxt0uTC/qTInJuascw4Sk5yku0qTtPNyKRLQoopWF/AibT13TOTQo9IatrdEHr2
    JiSherfbWfq1rs7tpq90i2zfUfOnNMVgc7olgM1y038iazZ3gmaBtqdN+Uhz1TtBi+6fJfiGOKdxuk4w3z/
    OKzbe9Lfc9drwO71us/913Kxe33CvSzZTbpTPNeuttsws5DXqT64TLgAf+suYeP0wb65abbqTkR1LcdLaUu
    5ptu64nuTzzlXX995ue4/55waHLPPrrZxrP/eSNy1588uJDX/f3sx8sPe9fc3499tD6THgKM3dRjAQD1CMF
    ZlT9XvLj5ludmRAnPOIFsDIGHF/zmNS90a1PdxhzX+7IpjDNLU4kUztPH8CxjgZMYAr82175Aki6BoZPfDe
    7IFkKhL70VaaFB8zbAynYPnpZb4Lw2xCXuuSfus1PCwuYwFEG4BErGA6AS/Ke85CoROX9iU5Za1EUXdQyYU
    nucssZ3vOw6ILaPetbEqwg71IWv/8w0u6HWVjHARAwgSJW4YjlayIKhRdHOsHQfCUEX+zmyLXMQRCMNvQcD
    i82SEKe0Q8HgIAD9EGBEYlwiQNUIAsj+cTGGfBm/rpiyxIYw4NVzoTR8yMNDxXGG4qRbKZcjpoegAD9qaEa
    6YAANN74SD5Oso4nlB0m77itPCZROSrshWZ8KclD0k5+t6ueIE8JuvcZUn0p0EcRGaAOWbKhlVmAIwP1uCE
    tMpGOThwgFJ83u0wuz3gpkuLVVFcm4nGxBV5M2OYCaUZm5tCe94TmCQLCFms8AByNfKUzXEkFbeoSnLbsJi
    5zedBbJlSAC1XoQ1UpymYCsmimJKMz93YwrmT/ZAQSWIA0heKRp6BBOOlwY0Ef6U6E/k+cliTnLsPJwF5ys
    oktZSgkXSjDiuazhhhdpkYLydHleLQsU1lLSdmChm6EpDQr9V9EIfpQYh7QqnjkpUsntlXYGfNgyIwgPTs2
    VHw+k6I86sZrlKqGA8DmBAmIR/Y8icT0tVOmLiXggW5aRZoqT45+JaE3KflO7czQovMMaj3LmsqelgB/A5j
    AcADgT4CqAQELmIpbR/AOfmYwUrVsqENFK1HSlpa0WAUsV3XqVX2C1WukHOv0GLtMtJ7gKdSM5SzPYA11FL
    Ea4IjABPBRK5Zucat6ZeEl7RhY59mUnMWEaE5Hu9Po2nY5/2G9qNgyml2zFtWxJ2ClK8XLhgW8FSoeIQBHV
    Go0qVZVq6wFJXXfNt/Wprar8nUtdmELJGUutruNxZwQNEvg8zpBAWtshv4eMI4NEXeuWaxrdO/6TYYmt0B8
    dagmWRu88E33q/udHlC3K1QA1xa8QFCHitnrBHT49iPkQMjtQrva+ubXqjON6H3je2MYFnZwPj1rbBVLVhP
    X87pBcABPJoDGFvDiqSZgxkBjRtfq/k+1F17dcg9kxXNuErqCfek2sZxfJK+su9QrZYkXFmANDkEu32BxFl
    ycUipHeKo7tvEvuTzCXsJXz3sGtHVRnDc0j/iP3GXziQU8BHQkkgAflP8CnZk6gicPwDN2zhvwemxlSAI2y
    0zJcGk3PN8OT/LD+i00f5Xl3yIr+siEBsIDhNOA3YogrreW6xAQPBWBqICImV7Zn09bY2K3lqqoHTayi73s
    Y8faNoYeMon/+
    +pVdxGNrMy2CfrHFDkTAQLlkTICGtAAbPbuhWJ2IpkrqVy88jndJXuuhHF6XJ2aGsSqFrG0Eb3mv7X52kXI
    LVLemoADLMABU8msEh6A8G2ruM7npp2y82zsMlOc4s22r48dGOTv9lfN1Pb3ot0sBAcoEiQq1YiKFxCBI0w
    60iSwNJQjXuVtBlqhWx4tqCsCZj83V0mqtbISUW1maFsbaCB3tcj/Yc1oIagRAQg2gQKgegReH2ACtpaCQZ
    mNcRwzV8cTD/tUi97FaH9ctmM08tENWwQHCHEA5oUEHFFdsyyPzN25JHWoew5Oun+Sm6k+89qn1OrZql3fT
    Q+CXdLR4BGoccWgHQnVtU5j+gp6wht/d0K7LvaJPrvsg+9X4dNebcSTXAgJMIauD5AAq2+WCA+HOC3dG9ih
    4/20Oxc1VfXe7HsLkOifh6fZWZ10w5eefcHnwQDwIYEDtBwKzog+QUuQAGEE2zadf+/YL55903q9j8cMvch
    G/0eiftG7tgP/EFAjgjZGuQGaNTDqVa8CjSxgAFmfllT9TkmYtrvCeedlGMZ3/yfEfzbHU4kneKYXKeRHQb
    TFdKeXYjwBbCUwDy9mBLnlD9PHI0SUJ8xADsBgfSIgDbpWIJWncX2GX4CXcfLFeSnIYzcXeEa3gEiHduWHf
    vL0b/D0QxAAAREQAXFXAoSRBCKFAIfxYJXGEz8YA7AkG9vgE98QDo13IJXnexTWf5+GPHtFgKMmgKXGacCX
    gDOIfGdHZMa3dOIHGD+0eP5Qgg0gf7A3gSzGbVEHA9uwFHaBD/rAD/4AEL4GFSHBbRL3gpcXZhPFfYRYcZz
    meWIIejTIKg2IWDhYIzrIdkWAP9NgAhOQWVMBhz+gSGcRhFARe0ioHea1FBgRahkxFEwVQv/7V2/UZXeOg4
    Vf12lA92Xz1newSGy+R3bCl4Y+YD2JhoaPCGREIHOTN2ne9gOw1A27VXAHNxUNsIEpABHFgIrYuIpLJWdbZ
    3mKCHjfB4M354J4lnmhFH7FKHrFR3rESIYR+APKWAXmZgIM8Fn083DG4GsAJRh5iBdVCIa3h2y5x4W754XG
    ZoWDNWYch47uyIDreIMPCIz1QQTixn4l4Hqe6AMToAAlyBEPIG7zyAIS0AySNQESoBhK1hiisQ+Q4Y+0x3X
    d543fOI4xKZPhiG8K2JA1aIbsqDmVaIwuV4oAEI9G4GIQIIIi8HgXuDJNohqTBQCu4Q9wOHe7uGyymHP/Gm
    aQPJeLBViVdVdmyccdw+eQNuiAh6eTljgETwYOyygaz2cEEaAA86BSAyAByHh9XVSTKHiIw0aO2seI7+iIa
    El4D2mWx3eDvsgDk/aWJ/ATSCBccwlXU9Ze6NZ/dpWQ4ZSF7DaAXNmFjxN0CGmLg9aIv5iO41eYkhiRpqmG
    RSBuHclr2yCUQWCUFJB1HCR7NHdnf7mbzMaC3OSX3meOODmGiLlv3jKMPjlyACcE0TeZJEBnDkCNQLCRHZm
    U99cLkwdarwhA6+Z/3YSVnhlJ8maZhmiAtbeQr7WawRiJ+aSag/lrhBN7lLYFDtBkrFmZvAmT29eXermIpp
    WYYimR/8rHns/knsVJmntxaUx2aRlZBQjmnLmpaRIWZuB5PJu5IbpnTp/ZVaEZhoFZmu95mmWZmmd5oO94a
    VJ5a8URA6HBFLKJBURZNi9pk/0Zg75Jk4l4o5c5dmH5a2O5k9OmdMkJgctZAm8IGvUwGtmpAgtwFIfRllVw
    l5Q5iKJpiD9XQAFZkBvKmeRJb9yJXGCJoAGqnqBCoBxloKO0MkdlAtsgAfw4hC6QgftAj0s6BFHJGAE1e/g
    ZnDl6kzNZTjUag34KoD4qoDsgjP02pIZaIGv6EengC2zFhL1AjfC3BO+wAFA3h5A3pTV3nh4WkBbqnRhKkB
    oqnhwKkF+qfiEWov80Y6bpt1Hn95PwiQKstIeRehnSqRoQ+mYRsEYUSAJW94cyuqf6WY77mYjAWaz/2aP08
    6OQiJrtWaJp+o7Wpw/414dwAQPNaE0lEKNEsAAU4HxupwLghpfwdDhe+XeiencAmJVbOqqdKVHmCW8/NqsM
    aaJkyZMQKa2SWHQrhwzuAA8xIBGhCHOVJhJ1GowqlkEMB6Uic4L+yad8iayBuqOAWaSriq9Aym8hp6hkSoV
    w1Qu1SQz0x6JyKJkKhgTh2gCMOQIvZ67asWngiJkvpZmiunfxWqo1daozW6X1Sj+H9VPGaVHIWX6yCrRtV2
    6HYbBRuJQUSQ64dpGahXUwyx3/FYt5xwp2fXq1P3uf6cmq6wmtBcqvQiumOpCBC7CBmWURmFaUsvGrUVWZ8
    2qLWNqu4bmzXHqA5Zmu5NlJH6odzkqYIxqthzmtGDt/mSiEGvEAy9eaBodwBuewVftrV2ulvYmIxpq5y2q2
    zbqoTOOq5zeJpqOcO1gEn6EC+3AADeCYRKBy6sByjjSjHQqq6zKQOdtl73qQqEpY6Jmxhruxx5moRku6aSk
    E7pcCCjAAi5ewPTB1W9CNe5mfx4a50hu9vcmsgBG46ji4Y1u4/Yq9N0AB1xkM1SidQCBjKTAVT0CVqRqLWv
    h/tKh5ereVXaqL7cuLYfq3Ywq2ZSq2Z0q2/0LGuTjgrb+AYAnAsi4XEYkLLZI7JRDbs5p7ufy5tRR8saV7r
    7/7rNz7v95btvqrAyC5gcLBRi/KjHKZDggMrNfQiZNLPzIrqDTraXn1vnnrVz4Hb87FszDss72bb/w7oP77
    quaXg8QLlENAgicgF77awDqwC70FpwSsLA+8wxEskzpaTMlKozwqwHihvSKqr4bZjhpbvEFwm2lrAqmLAKp
    bdeowAQxwvFPAvrxrbzSsZVmqs3+Fi/Xblfdrlfl7uDk5xoILxiTawQH8wTlwD0YoUpooDvPAvIp5lPkHAA
    9AATM3rFRavRFrxdQrsZpso+ArGV7cqkEcumj6vVxsA/9HsSEsNmspegS8AAD4I8KbismdSq90VKG1W8c4u
    8d3m8cctrsKqao+LMjbS8iEK8YZbMRlzBVjAcltJxtrLITgoMZN5orEqsVVPL0TvM3Wa8WhvDs3GEwfVTeg
    K0+iW0aeyxQ/NGkQVxLQrAMtCrdJiVn4w8Q4gM1UOrdXece4a6o1nG5eOsfuu4LhrM5jtEM89CW0cc4co8y
    ojMg4AJIpCwDyic834HYKAQFMS1kM0AAOoHCcqpueXNKc3M2fTMWbK9FdLKQ/LM4c69KoVMT22gTNWdGRsr
    B0Wg1nPNIS2re2Z7ehCitbeLs/Z7m4/Kl9TKide4YfC9PB27HDS6T/F/wEqyvL94cEDKC6LRvHU2yxKW1dn
    aysJu1sqQzVyfzUCB2kTj3V61w/LjCn7YDRqIcYDpCnESpsOJw4YHqh7Bq/AZi79Ku3Az3MBQ3KZ73WYazW
    sPpFRTvTVE3GQJAA9UAB2SnXdVgEriyKJHCpmdrCgFG5QWdxKF3W32zWLC3KMr3M+8vWPenWjM3ORQAByZs
    OXd0A5mVZRXkN21AeaUzPUiy7wpyZM3yhvUzYfbXXSC10uVyVTJ29qx3RxBnTbQ3Zb/1DagQB5BZlFsitRY
    DZLAau4trR2pnNp33eKzjW2hzWfgvI013I64yDGiO81h3bcG3RdpG83haSRZDV/7MmlBWhDvb4sNtJ0Pjr1
    7NoczkmmuOJ3Hxs4H5s0Ind2A8d2/ItNFJd3y9tgkUgHB8tlFJquirW1QDB1RD20+y93KRNsRXM3l3rkhgM
    3xaOqBmOWEfrtUIgAW/4AM7ncE5LBCtL4lHQjbMr1Lts3INtw8nN4Dq8ox7q3oK5r5ENuKWMzqfswVDeA/U
    4gl1dkfGcA8+AAhcN2ngh2ipoo+qN3hC80llO5dXN2oW6wUKczo2Nzs99A3TYltNcBAY3ARtIYPFH5pKBrn
    38lQgOnloK0PDqy/LKt3rb3lXtuzK+4XWO4dFtSDcO40HguuoA4r3AlrB8h3dtayNJyWHu0/967c2bzM0sr
    uprfr0TPsQVTulDPN81fk+ZPpFBAI2QO40+bttJgFnqoBzaTcnjiurYN6FBDdi4x8tJLtBLznt2U+QQfueq
    /ebSHeXU/doabsxIe4yf5ZpaLeoT0HCOd7LInpctbtrpXdpk/e6o3eatvdi0fuGdc+uYTtPfXgIRYIEOEZW
    c7QL/xHopTAKVfMlEgA4T8JYEBa4isN3pfq7KjdT9bLeJjreL7uC3xM9/HOnFTO/e3tTI3L0QjeUevyFMZg
    1BoaQxMMLD9evzyZyT3H5qRRqCrnns/uon3eopPtoSntpoTfIz7tBE47G03oHCJBkW8aYlLObhinJofBT/O
    J3wbfkAkhXweCLcPavLj/40Rc3oeBxvTY61T37y753W9U7jl743uX4gjUoCjXGrcd2raiyU5fomdG3LJA3v
    au5Cab7qfT+aQK/Ykx7y0C3npgzAHheYVm/zct8Cm3hwNn+R9YmdbBzo3VrLeZ3sPEzHh+7PR93gSv7ghn3
    giD34FF70aU/0Qc/2+o7jI/AA7xAZC+GHDWoCmy1/UTybmh9nvXb7NPPVWOvqfu/u653zCIj6sq76ht/SiG
    /lij/nRRePATuFICx9V3D3eo/innpqtNv1TRLQ1XXDTB7MW+/cB536rb/4Z59Dj23jr6/pMYewI1iy1yZ5U
    3DAmB9e/
    +YOAoA4kqV5ouUwpO04FIE803PBvnG9BzcJ82q+ny5owwGAxiNxycw5e0gXakVNDQyCLbe7NUyTWi9ZAL66
    smXyWaRed9uvMdw8fdftaGx4vycABhIc+BUaQggSlhwIThg+mlhBJukQ8FhKNdFg1hDcFXBuPkHJhM5YDiW
    Zlgp9su5gplJ27sgaSj7iwcm50dXxQuruIgmvARez3fkOT7r1NZ8gSE8jJEBfkxAwEABM9CkchE88YN8+7y
    k5yaYvrRcZ2bLDE7/Pa6q74jfj3i6XHfv7d84PsmRz8nwJUzCOMoR69g0sJ+IBuAQNIphIYE3iHwQOEIDjK
    JHfrXoBVv+5O3lp1KxTlxSuUkkjVbqYqPKJatXEpgxbhUgSDOgFoENguYQOJYaUoYqlCX84fQpRJIoGgBBM
    aGAiHNUrDgZMAKS1hMVwBxT4kUBhAAVyAB4wGMDALYAIbCVUiUhFXpCUUfy2U2iSB83BtXAGvmdvElB0UYk
    iNNqvqFLKTSM3xAytMVUCFA4gGKCIRAQIXalofNCgAd0RDhL5YQTINABEjGgrIABhwQK8kfSmqbQyEymXsD
    7x7CnYOC2ayVkqSQ741UzgLThfWcgFch7JP6M+FGMZquaD5Rlbv0YgAugDY0nIBjT6NImNbxmYIPC+UIQHD
    14jEIF+AFjVHwELAED/AQFoiRDaCgekV4VhOhWXWIV9LfcXPVEQ58aE1SmG4VTBPKYQeN4FNZ545/XConbb
    RZgXfSRMwNtr+JUAjlkMzjjCARQAkAAE84nQAI+QvCbBAJ6oMgACgwDw5GgOihZjJCah5Mpz09kE03Cj1LT
    SdNRBF4N0VqqApnm/mKgiYydWxuKKbJInpzk9TmTVAkeS8AACfrbWY26y9VHjjoYoiNaSLCwqZZRQ/rbPh2
    VyOCZhGerjYaWILaZppsGo2WJ3bdo52XkvSrUmM6quih6eQfqWgG8kbEMAAhDw2aOCH50QH6R75OZIggsCk
    BsFCehW14CRMiYcLMqF2CURW2LK/5NzX0JLypnRHjbiUXKiGt6bKobLXatz0untjBC6QSQADkDwkWivrrBC
    A1/hWI5VXzkpAQEfJfnuelbl+0Oonn7aUsJ8dRuiiAhbCHGnCk98J4ngwnlNuXGOelnHrBpzsDM9JnDAAg6
    Es4C7toIWEp6CBOJuMzCzwMBrDuAo5IG5jtzssxRqSq1i0v7wXLYKW8upTCBCsa2rF38MskAaZyxq1Fafu/
    FmIl/xpCALYFSCAxNAMMCer1IzjX2voiMyww1L/HDccM8N99tAUzzx3SxZ/O3V6J4LddRa15ku1oH3PaMCB
    ZsgICC9sS1CAmpHTpDbztLSYd5Eeyj0PUm/YP+05tENN2aW6n6HsZuCG0641EkVbjiobE8uzdojJHBX5bnF
    bIICPFeOXXaTHp233MbTjbzdxI/OvKXJ/3QwquYiburgVb/OVPbaPy0obI3rHrnKnjiQ6wQyB3/5z0wH/SW
    XL6kgemHMiWLp6U2X7rb0JXr8t9/Xr256mfFf9F41vgGUz3eBWMDtZmQrAjxgAPsRAQUWUC/GsU14e3Ge0i
    7lsOTtDUwc/CDdQqi5xKXub64b16mwd7ipbQ9GW3vVAyM4QQDoJ0ALuCF91uOeIW3le5VLgvqWlhPTwS8Hn
    isO6Nwgv3w4TWL3mx3rQtY/2VXRii+EYQzFtcJccA0NPmz/ABBLAAEEtCtyChiA4zBYO9sNsWfBGOGFjmfC
    eNBReXgzYfM0hLoUqdCFWeTiFwUYu+pZ7lVrbKPvICQaCGFwRhpBgV2U1EB6FTEn7JvFEinGOSdiq0Nhepb
    9Smim/P3RMaorVQoBuErZfRGFJLukr+TzqrjUawC34x0CGiCsIWowOJsi4R6Jh8dh1q2YyEwm3wo4SNgdUo
    v7wF4h+ddFcYGxR2mDI1m2eUmq1NJWJFgA2UKDvh4F8zqYOyKnPgmDTiJNTMR4oiaiuDnoJfKZ3NuiQTZDT
    UEa8pooQkM6ZwazX8VxKxSQxlkcsB+WYeWcMyqohJapx03eEVMR4+Pz/0zpx+5ZL3CxDGmrqukiQcpSJLm8
    YEJRsJ52zctH8bIKkOJI0RPwZYqcdB9iPqmKUM6PTC4ppTLtmVKCWlOgYXSdSa820nxq85stdY0FFbDDmEp
    uAbMJVAYzGbGLUiphYD0aRzvoUbE6838iRSlJpdlUWLIVqqd5ACIQO
    tUSRECrB0qAAmpKgmpM9aZXEuorkHicafFUBUVo4k/XVzzS/cywmzxqdpLKT2hOk1wAtexT29ajbUAAEZG8
    61ukgQKKuCdsNvWq3vI41mN+dKx9jO1r9cdCLHZWlS0MIGfj6tmJ0qZspM0IIjziVx8JQrXpk5RjH3vK9b3
    vsEUD6oYIq/8SomL0uZnziVxbudbVqbWkmz0peNN6GgSuAGVyGe4IdrMAkKyMBXSVKH0Eq1iLlpWYfMsvM8
    O6MGPaVp8yjCYXb9u68TrVtwQNYxoOSt/K+dCcJriIG3iIJ/vWE5UXcicoEvs5eYaOuhmObDvx+dvwFhhw0
    jSweHlLXlae2ARxGQFqKbwHKrGUvQBYwGciMDYTTABlB3AAyoBXX9ba0bUZvW9s+dtf59KWsnuxrIpTjGJC
    Ihiu5e1ug8LCDREwQgHF1bHGBIHGRTgYmEjWKRA6yQ6fLknECGOs8disXXamEqmvxOKV+1llP192wIEWNBV
    LwADZiMBfDgDANn5J5kn/fMbGj5ZjLpRs6Sg72cmy7ehkzevdFf8Zsyx2a5azpuDsONJJJQBEg6DkqEnDei
    RFtKc8OAzPUTZnnnL2FK3roVMpp4HKudXzbve84mHvJdVnHgGrH0WIV8d6D4c2SziMfFcM19GD2T7rVzdd3
    f/iF8B5rqyxQd1nzL7V1FuO8aq/rGhGE8DR0d5LmmGN7bjZ2YjMiW4nvNTcoOqbFdillFE9DUjcnprcxQ7k
    iwnI5SgtyRNoDPOY542GvA6CAdyc9L29rV//VizTl6btkkH66RQje8qadXGC173gE0w7HPipsXItTgW4IML
    CU6USu3wWcJlIdhPI8TATQQzKf0NR/8NSNPHLBZyqQT/d6alK97ETngYG27wFWDnQpHmOZG0/ebbdFnm4y4
    7WhxMb4S5P+4FZrmUYNz3rVLlVxi3e8Zx61M3vgDM952x0fOdd6dmUOvXM3VYsu13dcM8O1uUeP5g9OKF3H
    zm4xUp2klO+YgbXrdoXr3BXMrzlnr+646kS80PZe9aCr3USO0d0v5NS10gf8XZLjDdgX0fYVg/2yssN6JRf
    p/GlHz4RmYt5s489j5pevrhNfvDvjp73C+/82x3ObuJjf/BzbG4f9a5Jocdv17iun9LyXXC0fx761ud8230
    vauDzIfvyL3Slkf/Vkm8baMy3//FwjwXdr136tf+Y+
    +0T/MnI/CHg9RHEOhlH0J3C0EFXtfxdnM2etqyerzEd440aoIXaPkldeFBdgRkgTglfAkbb5PFfkmGa8mVe
    a0XZ5rEdqI0gTv1T4lVdAJKeCepg/Pnc90GZ99HPA4ZfBcZT7DmM+Qme/1UBAEZf7vVe6FUfn8HgDuogCh7
    fFSbfMu0fFmoe+qkcFErhySEeARLaDKYJFaKhwRhfr2VOvyFWBDLZz91EiBFhS7ChD57QFH4h9YXh8w0gGN
    5gEx5gGqKhFVbeIYYcC6Yg2NXWuO2h+vUh+/0hHwbi+mkgIRbimgUeHFYI34nfYv1dnW1i7Tmi9FGi4Ymhn
    4Xg7+3/Hg9i4g4a4v21ICN6XNhxWna9oBeaIiQikh+Smg2KYCsO4iuaoBXeYRCWAgS2IWzJoSj1Ha9dYBs2
    ky46ISCioi+OoTWyIg4GHzHC4tdxmyyuoBbOIiPin/Ydnqh1oKDh2Eq547Kt49SVWiVG4iV6YwLGImGlBBB
    aF5NMFxGO31CV3yjimfNJIspRUwUYwEIyZEMyZAUMUPtp4/sJIwneYzGCozJxYf9dHiK64NkpYAwi5BNG4S
    TyYjByoytepPwZYzTi4UkooyYxI2NRoDTO1jHqY4CdG6HFIwi6EFPNI0oKokWu5PzlowpuJC12pDgmZQbux
    f6QoaCtEFAC4zYO/yWzFGX2HSUSciLEeCJAgqIR1hFXkqJBiiQHUmXDSeQpWqUlPmVWsmRG4mJT3t5SfqRH
    0qIe7qIM1qBamiRf+uU1xh1cDl9Lkhi3SJfrdSXs5Rod2qRf4GTAcVdICuBITp/igR5bUmRKDiNhOt5RmmM
    51qUi0qVGdpteVqNmottP9uVEFmBFYqVnfqYmFtXrvVnrHd1jfhud4V1tHqZZViZatmZJ/mJUehFsnqFslh
    5ohuNdJiI5LmJz5iU1/p9x+qSbpKVrliFyqqFyzuYauiQywuQbLqMEimVj6SbtFeTS3R5qVqd2SiVrkuRJt
    mU9vqV3yh1zmiZTZmGTieZ+9v+fey6hdcrBVA4nfW7mVSbnCeSOLuEnfcCFXHBVd26fTXafbe4dbqKnDwIc
    b2IJQTagTqajB2YncWajam4nZxJl4/zLa9Tcg5aDbSSLSpZEdAKoUpImXoZmLlLmIwLmZdLjX1qmiXLgUSG
    CRswojEqEgGhFgdDoTzBgYdmeGyrR6xVhY+Ymhybdb7Jnp1HngMKnPGLngf4okarjUTVbsylpOSxKk5QAz6
    WaO8qpOx6ABRTAneJpnuKpBcRpnerpn94pn+aSnwJqngrqoNppoRpqqhGqogZqnyaqoxbAoT5IpCoqpc5pp
    j5InGqqnB6AQjpkqFYAp35qqJrqqNZLqZr/qkOiaqqC6qo+JKO+KqwaQKu6Kq0upK2KxqzCqq526pyGQ73A
    Y5p+2ZpiQ5u26V/96rIya7M667NCa7RK67RSa7Va67Via7Zq67YuKzxqlX9wnbFiQ6IUi2eI67miq2eGxQr
    EW7o2g6J5BAHMirvSa71SoWqIxYTaKxXYzL+M1r4CbMAK7MASbMEa7MEibBXMKyFKADzC6AAsLBoCSsIaq5
    z+qwlE2oumAMugSc8pgM5Rkns4rNblUsRWQbGm3kpdLMamVkf0nB88yUQQgFTVRwMcwMqmAC4F05OMLMUq5
    0HZVQrwDiBo7AmczMmgXgsoiXoNQBmhAbIEgsnKGMz0/yxOoeykAW3kicDQvtQVHK2QncUVMMC6DkBuVG0J
    6JU2GIKXBQIV8KzPKuk2AdYVMIlqaC0DpK0tuYDXCEKMmE0E5JV1LEkETIO+RkK9sZfc0uyqyZfNogHeQt4
    V1NICGO4IPMlCOe0eDBk1uC3Qwi1+vtHiMlvYuAwaLI4f+AkETMDGEZQivKzSQs5PIC6Zhe4fkK7Wbi3Oko
    WCFG7XfBlW7YGPwaznfq5scq3WWsUBIMJxXUElOajYzoUvyW7ktgBdmRlBXS2sHe8eJO/y8gfEPi8VKIkEH
    NrZ/hXxPm3edq75Fm9RHlACXQG+no0f8JL0egUFeBnzNhj1YoFumP+F6DqRzb2vtZWA/BKwAtmK/fJrbzyO
    7x5UbAyCWaxv+z5oDUkQnpDTGQFvC9jKkJTuaWzDIzSszVkwyEpEBksYqgmIgLAvNpwP6v4JBePnGGVuC+j
    M/LpsRKGBBXnCBjdYIUgAOdWL1MoYITAAfvwO1rIHGeHuDR/wqiEAaLzwFVDA2HCDOO0tFj+CgOQSahzA5N
    QM7sqwDi4SIOiuwCivP6KB8jqUuV4BL6kuQWRvFl9vdnADV3DFo5Wx2qLBa6RxjLAxTaFBEA+CgBCx5WrxL
    cDM+i6JKoyxZ06SGIWN4+5BAugVBFRun1BAf4SvHVNb2FZv2mRy6AAAHotx5UT/siQXiRhb8lbd2AA8QATo
    bzT4L7WlRdowMjc08iOv5AOsxQqc8Xolgbx1DQCTBvgasxPxbwr4Se96Mm+YzCnjiS/nWHbgCFgYwtzugVp
    o3CybAN8KAhBzbhbHyyC8Bi+v5Gv0juTOLgp8crWZ7lUosB2nzeISciC0sDILkY6ps96y8zK78zs/MQAQ8h
    fLa+cu1Dhf3CLTMUOjszfmEOu2gI5Q2wFn7Q6Xkw9fxxy3gIKIQ+yKrzdhbQNQjukKNBVcNBVbECEkMgq8L
    STcy9go783J7UPfowIQ881NAq90Q3pA1BSjQWj8BISgxcxSIU4/wiinAE97Q+tGsb+08PhO/wKEHADhIohN
    n2ut+LMLyNwjuPEHt0Agu/HjHgkDEHDTIsCetDQCanXQpkBXG8JXa+2T3MtuXEHJ1IcYn0XTWgVWn+uBJK0
    L8A45JXMpDwIi5DSDXrJSvwC/bKoLlIwEIAImUyFgw3M8H8gEFDYjpHFinwDb6u6T5FJY+AEDNAAhe7Zfy+
    ZXJDXk6kbRmgC+6gdjN0hh6/M60zRtyx1rt/Ylw3YBW8Vs3zJjg3PbGsIIq7axKoBjnzFfqbMfz4jOrkAyo
    1eqnlPDbpNu29xyVzNqLDcgQDd9KEkuzUUWjzZHZ0RNJ7eS+orWMkL54AX5rstB5TOjlbWRRRzVUmF7a//u
    vyhAfJ8xJBS3W+d1gf+zQ6836FKDMW9y5fwIQy23CQu4nB4y8b2RNlNBg0fOrUgD3i6JbUubnCY4jB7xLdf
    zy4RNlUgzqinJK5a4iS/4hdEGDr00ODlJgI/4RVIy9gJ0JRuzA1TVVa34XjgA7zqzDu44j+
    +zH6SyC2xDA4jGzK51ObhHOU1DjuOnzZR0C0wbNIPyzXG2NeQxFWDcXvVVVwz4lMuflks0CnS5yny5CzxAm
    Jcy7saHZh+AdqMD+mK5Z/L3Gp8y2zLQmNN0fTfD1pXsfi85Vwf6ApUMKyNAhZfDoTl2CfZ56Ul3gBO65DpA
    6i5ADadAWVw2hBo68WX/emyc8pB5OqhjAbWB+HG/
    +qUTIoZzecrA+UDn8QNoldb2M4FzxCOFQ6zPG63XusncOqBPxK4/rn73yAOcjwTLOmG2sm6Mcn7jtgsoSKy
    ojBhJuES0tZpn37RTNr31OApke1Zp7YdXDtuqabQXJZGVLTmF9Ik/QpO3gJFEjroTIrxbVWqPAHbHeL0bM7
    LoeTOourvLJhZrNHsZyqifBsFjosIP+atY8pAEO55QwIwjPFw6VIDEcb6796KLRMX/LxV2fGn4O1Us/Dcze
    3RH8KZvPDFqNQPNSDvCfOK2vAnOvLAH9UrdvI5ZO3rHfBrmDgVI+ma0sw2HD8IW/dEjfbmf/1Zc/PbQU/0J
    SAC8P7bYOroDDWupi+vVO/bPx3ZdtWvNo2zMVj0mBr2vs+lorDzaknRpdPsk1HI4gHthJr3Ku73WVpDG6ft
    pSIlZIELaY2LMqfPE94jEOxB966DhbzXHjcbdX0OaE/4rUgQgKEDBv0q8xPtAQ4JnUIPkD9/lL4jmv4qAeA
    MjmL7vUoOCVD4h+tggOD00MEBbcDZji/vq78W8QuwOxv4BzD7t2/4g0DZo90iL/7ulv/5dKciCbDmag3cge
    H6U8PyDNr8CPD/0/4v0D/fyU+zaI/5eWJC8J7lLV7UIsIfXryn4o9P4O0L5o0BWjMA8ez/BtqMwnxchsPfL
    24sACEwLQALLVKbqyrbuC8fyLCPDjTP0ng4HcBgAfDEJgVKiECS8pvMJjUqn1Kr1iuUNCNzuD3b4ksLZsvl
    s3na5YheCgCi94+i6/Y7P6/c09brdcrDwQPKwAMiXqDjl5xXzJkSyRbdYaXmJmYnJQOBw43CkKToqBToxME
    EwQsra6vrqmuoIS0ubsNC1EFHL2+v7O5VwswtcfPnAMEDBZNzs/AwdLT1NXW19jZ2tvc3d7f0NHi4+Tl5uf
    o6err7O3u7+Dh8vP09fb3+Pn6+/z9/v/w8woMCBBAsaPIgwocKFDBs6fAgxosSJFCtavIgxo8aNvUIAADs=
    );\">",
    " </div>",
    " <div class=\"lgnd\">",
    " Bone marrow analysis was performed in normal subjects and patients with a
    variety of hematological conditions: hypoplastic bone marrow states (Hypo), B12
    deficiency (B12 def), congestive splenomegaly (Congest), immune thrombocytopenia
    (ITP), chronic inflammation (Inflam), and essential thrombocythemia (ET). Left
    panel: The amount of megakaryocyte cytoplasm per diploid (2N) amount of nuclear DNA
    was similar to normal in all of the disorders. Right panel: When the platelet
    production rate was measured in kinetic studies and then divided by the number of
    diploid nuclear lobes of the megakaryocyte, the amount of platelets produced per
    diploid amount of nuclear DNA was normal in all disorders except for hypoplastic
    marrow states and B12 deficiency in which ineffective thrombopoiesis was present.",
    " <div class=\"footnotes\">",
    " </div>",
    " <div class=\"reference\">",
    " Data from: Harker LA, Finch CA. J Clin Invest 1969; 48:963.",
    " </div>",
    " </div>",
    " </div>",
    " </div>",
    "</div>"].join("\n");
    var script_f6_13_6367=[""].join("\n");
    var outline_f6_13_6367=null;

    Vous aimerez peut-être aussi